Form

Application for Employment

To be considered for employment, all job applicants must fill out this form completely. Prospective employees will receive consideration without discrimination due to race, sex, age, creed, national origin, disability, or other protected status as required by law. PFS is an Equal Opportunity Employer.
Full Name *

First Name Last Name
Upon hire, can you provide proof you are legally authorized to work in the United States?

Yes No
Phone Number *

- Area Code Phone Number
Cellphone Number
Social Security #

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Position Applying for *
Pay Expected
EMPLOYMENT

Please give accurate and complete employment records. Start with your present or most recent employer.
NOTE: We may contact the employers listed below unless you indicated those you do not want us to contact.
Do Not Contact: *
Reason
Company Name
Phone Number
Address
Employment Dates (MM/YYYY) to (MM/YYYY) *
Job Title *
Hours per week:
Hourly Pay Start
Hourly Pay End
Job Duties
Supervisor (Name & Title) *
Reason for Leaving
Company Name
Phone Number

- Area Code Phone Number
Address
Employment Dates (MM/YYYY) to (MM/YYYY) *
Your Job Title *
Hours per week
Hourly Pay Start
Hourly Pay Last
Job Duties
Supervisor (Name & Title) *
Reason for Leaving
Education

Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for.
Put NA in fields that do not apply to you.
Graduate
Name & Location of School
Course of Study
No. Yrs. Completed
Did You Graduate?

Yes No
Degree or Diploma
College
Name & Location of School
Course of Study
No. Yrs. Completed
Did You Graduate?

Yes No
Degree or Diploma
High School
Name & Location of School
Course of Study
No. Yrs. Completed
Did You Graduate?

Yes No
Degree or Diploma
Licenses/Certifications/Other
Name & Location of School
Course of Study
No. Yrs. Completed
Did You Graduate?

Yes No
Degree or Diploma
Military

Complete This Section If You Have Served in the U. S. Armed Forces.
Branch of Service
Period of Active Duty - (Month & Year)
From
To
Describe your duties and any special training
Skills

Use This Section To List Additional Skills, Qualifications and/or Certifications.
Computer:
Office:
Warehouse:
Other:
Do you speak, read or write any other languages?:
*If yes, please answer below

Yes No
Language:
Proficiency:
Language:
Proficiency:
Language:
Proficiency:
References

Provide At Least 2 Additional References (include personal or professional).
Name:
Relationship:
Company:
Years Known:
Contact Info (phone, email, etc):
Name:
Relationship:
Company:
Years Known:
Contact Info (phone, email, etc):
Name:
Relationship:
Company:
Years Known:
Contact Info (prhone, email, etc):
Additional Info
Please explain any gaps in your employment:
Have you ever been fired or forced to resign from employment in lieu of termination? If yes, explain:
Have you ever worked for, or applied for a position with PFS before? If yes, when?:
Are there any days or hours in which you are unwilling to work? If yes, indicate below:

Yes No
Sun Mon Tues Wed Thurs Fri Sat Nights Mornings
How did you hear about this opportunity?:

Newspaper Internet Ad Friend
Emergency Contact Info

In case of emergency, please provide additional contact information
Name:
Relationship:
Phone #
Alternate Phone #:
Medical
Have you had a physical examination in the past 5 years?

Yes No
Would you be willing to undergo a physical examination if required?

Yes No
PFS is dedicated to a Drug Free Workplace. Would you be willing to undergo a drug screen as a condition of employment if required?

Yes No
Do you smoke?

Yes No
Can you perform the essential functions of the position of which you are Yes No applying, with or without reasonable accommodation?

Yes No
Will you abide by the safety rules of this company?

Yes No
READ THE FOLLOWING CAREFLULLY

I hereby apply for employment with PFS (hereinafter, referred to as EMPLOYER). I specifically verify that all information provided in the APPLICATION / RESUME FOR EMPLOYMENT is true, complete and correct.

I understand & agree that the omission or misrepresentation of any fact in the APPLICATION / RESUME FOR EMPLOYMENT will be sufficient reason for EMPLOYER to deny me employment. I also understand and agree that should I become employed and it is later discovered I have omitted or misrepresented any fact in this application and/or resume, or any supplement thereto, or any other corporate record, Employer may immediately terminate my employment upon discovery of such omission or misrepresentation.

In connection with my application, I authorize EMPLOYER to obtain a consumer report containing information regarding my prior driving history, criminal history, education and/or credit in connection with evaluating me for employment, promotion, reassignment or retention as an employee. I understand that PFS is a Drug Free Workplace and that I may be required to undergo drug screening prior to employment. I understand and agree that my employment and/or continued employment with PFS are contingent upon the results of my background investigation.

I understand that, if employed, my employment is not for a specific term and may be terminated by me or EMPLOYER with or without notice or cause at any time. I further understand that no oral promise, Employer policy, custom, business practice or other procedure (including the Personnel Handbook or any personnel manuals) constitute an employment contract or modification of the at-will employment relationship between me and the Employer. I understand that after 60 days from the date signed below that I must resubmit a new application to be considered for any future opportunities with PFS after this application has expired.
Please sign and date this form below.
Signature *
Date *

- Month - Day Year
Pre-Employment Disclosure Authorization Form
In connection with my application for and any subsequent employment with Professional Flooring Services (hereby referred to as "PFS"), I understand that their agents or employees may be performing, requesting, obtaining or conducting a background check on me. This background may include an inquiry into my Employment History, Education, General Character or Reputation, Work Experience, Workers Compensation, Volunteer Experience, Driving and/or Criminal History. If my position involves handling money and/or having access to monies and/or other transferable monetary instruments, my Credit History may also be checked.

I understand that PFS may rely on any part of this information in determining whether to extend an offer of Employment to me. I further understand that if any adverse action is taken by PFS or if PFS chooses not to extend an offer of Employment to me based upon the information, that I will be provided a copy of such information with a summary of my rights under the Fair Credit Reporting Act.

I authorize any persons, organizations, schools, companies, employers (past or present), credit bureaus, investigative agencies and/or law enforcement agencies to supply PFS any information oral or written, driving records, court records, credit records (if applicable) and or/any documents concerning my background.

I have read this Pre-Employment Authorization and by signing below, I release PFS and its agents from any and all liability, responsibility, damages and claims arising from this investigation of my background. I agree and understand that a photocopy of this authorization may serve as an original. This authorization in original or copy form shall be valid for this and any future reports or updates that may be required.
Full Legal Name

First Name Middle Name Last Name
Other Names Known By (Maiden Name, Legal Name Change, Etc):
Social Security Number*:
Date of Birth: *
Drivers License Number**:
State**:
Previous Addresses (if less than 7 years at current address on application):
#1 - Address, City, State, Zip:
#2 - Address, City, State, Zip:
*All information requested will be used for employment/background checking purposes only.

**Note: Due to insurance regulations, it is required that we obtain a copy of your driving record.
Signature *
Date: *

- Month - Day Year
EEO VOLUNTARY INFORMATION FORM

It is the policy of PFS to provide equal employment opportunity to all qualified applicants for employment without regard to personal characteristics, including race, color, religion, national origin, sex, sexual orientation, age, veteran status, or disability. Various agencies of the government require employers to inviteapplicants to identify themselves. That is the only goal of this form.

Completing this form is voluntary and in no way affects the decision regarding yourapplication for employment.
Full Name

First Name Last Name
Position Applied For:
Race/Ethnic Origin:

White/Caucasian Hispanic/Latino American India/Alaskan Native Black/African American Asian Native Hawaiian/Pacific Islander
Gender:

Male Female
Veteran:

Yes No Disabled Veteran
Disabled

Yes No
Or:
I decline to offer this information
Do Not Contact

Yes No
Should be Empty:

Application for Employment

EMPLOYMENT

Education

Graduate

College

High School

Licenses/Certifications/Other

Military

Period of Active Duty - (Month & Year)

Skills

References

Additional Info

Emergency Contact Info

Medical

READ THE FOLLOWING CAREFLULLY

Pre-Employment Disclosure Authorization Form

EEO VOLUNTARY INFORMATION FORM

Or: