Imperial
  Industries
    Incorporated

Application for Employment

TO APPLICANT: We sincerely appreciate your interest in Imperial Industries, Inc. as a prospective employer. Thank you for taking the time to complete this application.

The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits other types of discrimination such as age, citizenship, disability, veterans status, and participation in union activities, ancestry, marital status, parental status, or sexual orientation. The Fair Credit Reporting Act imposes restrictions with respect to credit data. This list, however, is not exhaustive of the grounds on which discrimination is prohibited.

(Please Type Carefully)

Personal


Date: May 13, 2008
First Name: Middle Name: Last Name:
Social Security No.:     must be provided upon request  
 Telephone Number:
Address:
No.   Street City State Zip
Are you eligible for full time employment? (i.e. 40 hrs/wk) If hired, you are required to submit proof of your eligibility to workYes No
Are you over the age of 18 years old?
If no, hire is subject to verification that you are of minimum legal age.		Yes No

Position(s) applied for:  
 
Were you previously employed by us? Yes No   If yes, when?

If your application is favorable, when will you be available to work?  

Are there any other job related experiences, skills, or qualifications which will be of special benefit in the job for which you are applying for?
Have you ever been convicted of a major crime?Yes No
(Excluding minor traffic violations, sealed or expunged records, or cases where you were found not guilty)

Employment History

List below present and past employment,beginning with the most recent.


Name and Address of Company
and Type of Business		 From To Weekly
Starting
Salary or Wage		 Weekly
Ending
Salary or Wage		 Reason for
Leaving		 Name of
Supervisor
Month/Year Month/Year
Telephone:
 
Name and Address of Company
and Type of Business		 From To Weekly
Starting
Salary or Wage		 Weekly
Ending
Salary or Wage		 Reason for
Leaving		 Name of
Supervisor
Month/Year Month/Year
Telephone:
 
Name and Address of Company
and Type of Business		 From To Weekly
Starting
Salary or Wage		 Weekly
Ending
Salary or Wage		 Reason for
Leaving		 Name of
Supervisor
Month/Year Month/Year
Telephone:
 
Name and Address of Company
and Type of Business		 From To Weekly
Starting
Salary or Wage		 Weekly
Ending
Salary or Wage		 Reason for
Leaving		 Name of
Supervisor
Month/Year Month/Year
Telephone:
 
Name and Address of Company
and Type of Business		 From To Weekly
Starting
Salary or Wage		 Weekly
Ending
Salary or Wage		 Reason for
Leaving		 Name of
Supervisor
Month/Year Month/Year
Telephone:
 

Educational Record

 
School Name and Address Subjects Studied Number of
Years
Completed		 Did you
Graduate?		 Diploma,
Degree or
Certificate
High School Yes
No
College or University Yes
No
Vocational or Technical Yes
No
 

Personal References

 
Name and Relationship Address Phone Number
 
 

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SUBMITING

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.
I further understand that this application is not intended to be a contract of employment, nor does this application obligate Imperial Industries, Inc. in any way if they decide to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason at all.
I authorize Imperial Industries, Inc. to do a background investigation on me. This includes a request from previous/present employers as to my employment history, personal references and school records and I hereby release all persons and corporations requesting or supplying information from all liability or responsibility to me in doing so.


This application will be kept on file for one year from the date of application.