Macsons Employment Form

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Employment Application

HAMPTON ROADS VA • WILMINGTON NC • JACKSONVILLE NC• MYRTLE BEACH SC

PLEASE READ THE FOLLOWING APPLICATION WAIVERS CAREFULLY

In exchange for the consideration of my job application by Macson's Inc. (hereinafter also known as “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, beneﬁt plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Macson's Inc. or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Macson's Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their beneﬁts, policies and procedures and such changes may include reduction in beneﬁts.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I authorize Macson's Inc. to obtain criminal background reports and/or investigative criminal background reports for the pre-employment background investigation, and, if I am hired, at any time during my employment. I understand that these reports might include, but are not limited to, a search of my criminal background, reference checks, driving record checks, and veriﬁcation of my identiﬁcation and Social Security Number. I agree that this Disclosure/Authorization, in original or copy form, is valid for all current and future criminal background reports.

I understand that Macson's Inc. may use such criminal background reports for employment purposes, including, but not limited to, hiring, promotion, retention, and termination. If the Company obtains a criminal background report or an investigative criminal background report about me, and if the Company considers any information when making an employment decision that directly or adversely affect me, I will be provided with a copy of the applicable reports before the decision is ﬁnalized.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Macson's Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualification.

Thank you for completing this application form and for your interest in our business.

Required

Date: Date / Mo-Dy-Yr

Are you currently employed? Currently Employed:

YES

Name Enter Full Name

Email Enter Email

Address Home Address

City City

State State

Zip Zip Code

Other names Other Names Used

Birthplace Place of Birth (City & State)

Home Phone Home Phone Number

Position Position Applied For

Starting Date Date You Can Start

Mobile Phone Mobile Phone Number

Salary Desired Salary

Referred by Referred By

High School

HS Name: Name

HS City & State: City & State

Years Completed HS Years Completed

Diploma HS Major & Degree

College

College Name: Name

City & State College City & State

Years Completed College Years Completed

Major & Degree College Major & Degree

Business or Trade School

Business - Trade School Name: Name

City and State Bus or Trade School City & State

Years Completed Bus or Trade School Years Completed

Major & Degree Bus or Trade School: Major & Degree

Professional School/Certificates

Prof. School / Certificates: Name

City & State Professional School City & State

Years Completed Professional School Years Completed

Major & Degree Professional School Major & Degree

YES

Comments - Violation Background: Enter Your Message

Required

YES

Driver License No. Driver License No.

State of Issue State of Issue

Driver License Exp Date Expiration Date

Means of Transportation to Work What is your means of transportation to work?

YES

Accidents in Past 3 Years: If Yes, how many?

YES

Moving Violations Past 3 Yrs: If Yes, how many?

YES

US Military or Naval Service: US Military or Naval Service

Rank: Rank

Date Entered Military: Date Entered

Date Discharged Military Discharge Date

Required

Description of Job Related Training, Apprenticeship and Skills: Enter Your Training / Special Skills

Required

Additional Info - Summary of Qualifications: Enter Full Qualifications Here

Work Experience 1-Employer: Name of Employer 1

Work Exp 1 - last Supervisor: Last Supervisor

Work Experience 1 - Dates Employed: Dates Employed From / To

Work Experience 1 - Pay Rate or Salary Pay Rate or Salary Start / Final

Work Experience 1 - Employer Address: Employer's Address

Work Experience 1 - Employer Phone No: Employer Phone Number

Work Experience 1 - Last Job Title Your Last Job Title

Work Experience 1 - Reason for Leaving Reason for leaving (Please be specific)

Required

Work Experience 1 - Jobs, Duties, Skills, Etc. List jobs, duties, skills, advancements and promotions:

Work Experience 2 - Employer Name: Name of Employer 2

Work Experience 2 - Last Supervisor Last Supervisor 2

Work Experience 2 - Dates Employed Dates Employed From / To

Work Experience 2 - Pay Rates and Salary Pay Rate or Salary Start / Final

Work Experience 2 - Employers Address Employer's Address

Work Experience 2 - Employer Phone No: Employer Phone Number

Work Experience 2 - Last Job Title Your Last Job Title 2

Work Experience 2 - Reason for Leaving: Reason for leaving (Please be specific)

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Required

Work Experience 2 - Jobs, Duties, Skills, Etc. List jobs, duties, skills, advancements and promotions:

Work Experience 3 - Employer Name: Name of Employer 3

Work Experience 3 - Last Supervisor Last Supervisor 3

Work Experience 3 - Pay Rate or Salary Pay Rate or Salary Start / Final

Work Experience 3 - Dates Employed Date Employed From / To

Work Experience 3 - Employer Address Employer's Address

Work Experience 3 - Employer Phone No Employer Phone Number

Work Experience 3 - Last Job Title: Your Last Job Title 3

Work Experience 3 - Reason for Leaving: Reason for leaving (Please be specific)

Required

Work Experience 3 - Jobs, Duties, Skills, Etc. List jobs, duties, skills, advancements and promotions:

Work Experience 4 - Employer Name: Name of Employer 4

Work Experience 4 - Last Supervisor Last Supervisor 4

Work Experience 4 - Dates Employed Date Employed From / To

Work Experience 4 - Pay Rate or Salary Pay Rate or Salary Start / Final

Work Experience 4 - Employer Address: Employer's Address

Work Experience 4 - Employer Phone No: Employer Phone Number

Work Experience 4 - Last Job Title Your Last Job Title 4

Work Experience 4 - Reason for Leaving: Reason for Leaving

Required

Jobs, Duties, Skills, Etc.: List jobs, duties, skills, advancements and promotions:

Reference 1 - Name: Name 1

Reference 1 - Professional Relationship Professional Relationship

Reference 1 - Title & Company: Title & Company Name

Reference 1 - Years Known: Years Known

Reference 1 - Phone Number Phone Number

Reference 2 - Name: Name 2

Reference 2 - Professional Relationship: Professional Relationship

Title & Company Name

Reference 2 - Years Known: Years Known

Reference 2 - Phone No Phone Number

Reference 3 - Name: Name 3

Professional Relationship

Reference 3 - Title & Co. Name Title & Company Name

Reference 3 - Years Known: Years Known

Reference 3 - Phone No: Phone Number

Date of Birth Date of Birth

Social Security No: Social Security No.

Applicant Typed Signature Applicant Signature (I understand that my typed name counts as my signature.)

Date of Application Endorsement: Date

Personal Information

Education

Background

Work Experience 1 (latest)

Type of School

Have you ever been convicted of a felony?

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give the company name.

Please list below the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Do you have a valid Driver's License?

Have you ever been in the armed forces?

Describe an job related training, apprenticeship, or skills you have:

Use this space to summarize any additional information necessary, describing your full qualifications for the specific position you are applying for:

Are you now a member of the National Guard?

Have you had any accidents during the past 3 years?

Have you had any moving violations during the past 3 years?

If yes to either of the above, please explain number of convictions, nature of offenses leading to conviction(s), how recently offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:

Have you ever been convicted of a misdemeanor?

Name of School

Address

No. Years Completed

Major & Degree

Work Experience 2 (prior to 1)

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give the company name.

Please list below the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Work Experience 3 (prior to 2)

Work Experience 4 (prior to 3)

References

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give the company name.

Please list three (3) references (who are not related to you) such as previous supervisors, colleagues, volunteer supervisors, teachers, or others:

Please list below the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Work Experience 2 -

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