Employment Application

Name:
Address:

City:	State: Zip:
Phone:
Email:

Married Single

Are you 18 of age or older? Yes No
(If not Date of Birth)

Previous Employment
(List up to three previous places of employment most recent first)

Name/Type of Work

Length of Time

Reason for Leaving

1. Any objection to Saturday work? Objection to overtime?

2. Have you ever been disciplined or fired? If Yes, Why?

3. Salary requirements per hour or Salary requirements per year

4. Office/Clerical Only --List your typing/keyboard and calculator experience and proficiency

5. Sales & Yard Only -- Are you capable of lifting 100lbs of building materials?

References

1.	Name:
	Address:

	Phone:

2.	Name:
	Address:

	Phone:

3.	Name:
	Address:

	Phone:

Education

School:
Grades/Course Completed:
Year:
School:
Grades/Course Completed:
Year:
School:
Grades/Course Completed:
Year:
Optional Comments:

Type of Employment Desired Part Time Full Time

Yard & Delivery	Counter Sales	Hardware Dept.
A/P Dept.	A/R Dept.	Cashier

By submitting this application for employment I hereby authorize A.D. Moyer Lumber Co., Inc. to contact prior employers listed above to obtain any and all information related to my past work performance.