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Join Our Team at Chapman Lumber Inc
Thanks for your interest in joining Chapman Lumber Inc.


Mail your resume to:
Hiring Manager
Chapman Lumber Inc
224 Watertown Road
Thomaston, CT 06787
Chapman Lumber, Inc Application for Employment


Candidate's Name: _______________________________________ Date: ________________

Address: ______________________________________________________________________

Telephone Number: ______________________  

Are you 18 years of age or older? 
 Yes  No

Are you either a U.S. citizen or an alien authorized to work in the U.S.?
 Yes  No

Have you ever worked or attended school under another name? If so, under what name?
______________________________________________________________________________



Position Desired

Position: ____________________________ Start date available: __________  

Wage rate desired: $ ___________  Hourly  Monthly  Annually  

Do you prefer:  Full-time  Part-time If part-time, hours per week desired:_____________

Hours you are available to work: ___________________________________________________

Days of week you are available to work: _____________________________________________

Are you able to work:  Saturdays
 Holidays
 Nights
 Overtime

Have you previously worked for Chapman Lumber?  Yes  No

Dates of employment with Chapman Lumber: from ___________ to ___________ 

Reason(s) for leaving: ___________________________________________________________

Former supervisor(s) at this company: ______________________________________________

How did you learn about this opening? ______________________________________________



Education
High School: 
Graduated?
 Yes  NoCourse of Study: 
Technical School: Graduated?
 Yes  NoCourse of Study:

College/University: 
Graduated?
 Yes  NoCourse of Study:

Post-Graduate Education:Graduated?
 Yes  NoCourse of Study:

Other education, training or special skills: 







Skills

Are you experienced in using personal computers? Yes No  PC  Mac
Can you operate a forklift? Yes No
Can you operate a table saw? Yes No


Work Experience
Please list all previous employment, beginning with the most recent. If you need more room, you may attach another sheet of paper.
Employer: Address: 

From To Position Held: Reason for Leaving: 

Supervisor's Name & Title: May we contact?
 Yes  No
Description of Duties: 


Starting Compensation: Final Compensation: 
Employer: Address: 

From ToPosition Held: Reason for Leaving: 

Supervisor's Name & Title: May we contact?
 Yes  No
Description of Duties: 


Starting Compensation: Final Compensation: 

Employer: Address: 

From To Position Held: Reason for Leaving: 

Supervisor's Name & Title: May we contact?
 Yes  No
Description of Duties: 


Starting Compensation: Final Compensation: 
Employer: Address: 

From ToPosition Held: Reason for Leaving: 

Supervisor's Name & Title: May we contact?
 Yes  No
Description of Duties: 


Starting Compensation: Final Compensation: 


References
Identify three persons who know your work, beginning with the most recent.

Name: ____________________ Phone Number: _______________ Email: ____________

Address: _________________________________ City, State, Zip: ____________________

Position or Title: __________________________________ Years Known: ______________


Name: ____________________ Phone Number: _______________ Email: ____________

Address: _________________________________ City, State, Zip: ____________________

Position or Title: __________________________________ Years Known: ______________



Name: ____________________ Phone Number: _______________ Email: ____________

Address: _________________________________ City, State, Zip: ____________________

Position or Title: __________________________________ Years Known: ______________ 




Authorization and Acknowledgements
I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. 

I authorize the company to verify my background, references, record of employment, education record, criminal record, driving record and credit history and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.


________________________________________________________________
Candidate's SignatureDate


___________________________________________
Candidate Printed Name