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11/17/2017 2:06:38 PM

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Southco Distributing Company Online Employment Application

Last Name

First Name

Middle Initial

Home Phone

Friend / Neighbor Phone #

 

Current Address City State ZipCode How Long Years/Months

Previous Address City State ZipCode How Long Years/Months

Drivers License / ID # 18 years of age or older
Yes  No
Southco Distributing Company is an Equal Opportunity Employer and abides by local, state and federal law in regard to discrimination because of age, sex, race, national origin, creed, religion, disabilities and/or veteran status.
Have you previously worked for Southco? Yes No If Yes, please provide the dates you worked for Southco.
Date worked from: Month/Year Date worked to: Month/Year
US Military Service Dates: From: Month/Year Branch:  
To: Month/Year Highest Rank:
Type of Duty(s):
Have you ever been convicted of a felony? Yes No  If Yes, please explain (Disclosure of criminal record does not automatically disqualify you from employment consideration. Your case will be judged on its own merit.)
If employed, do you have a reliable means of transportation to get to work? Yes No

Are you willing to work overtime and on weekends if required?                       Yes No

Education Information
Name/Location Dates
From/To
Date Graduated Degree/Diploma Last Year Major Subjects

Grammar School:

/

High School:

/

College/Tech/Other:

/
Honors / Scholarships: Scholarships or honors that may reveal race or ethnic status need not be listed.
Student Activities: Sports, class offices, etc. Organizations, which may reveal race or ethnic status, need not be listed.
References:
List any of your relatives that are currently working at Southco:
List any of your friends that are currently working at Southco:
Employment History (List in reverse chronological order with last employer first)

1. Most recent employer

Employment Dates

Job Title Supervisor(s) Name

(Company Name)

From To

Company address:

Phone number:

Position(s) held:

Reason for leaving:

Describe Duties:

2. Next recent employer

Employment Dates

Job Title Supervisor(s) Name

(Company Name)

From To

Company address:
Phone number:
Position(s) held:
Reason for leaving:
Describe Duties:

3. Next recent employer

Employment Dates

Job Title Supervisor(s) Name

(Company Name)

From To

Company address:
Phone number:
Position(s) held:
Reason for leaving:
Describe Duties:
 
Do you have a current fork lift or CDL license? Yes No
Please include the details of any license or certification below:
Do you have a WorkKeys Career Readiness Certificate (CRC)? Yes No
www.waynecc.edu/works If yes, what is your Career Readiness Certificate level?
 
Date you could start at Southco: Expected Salary: Date:
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