Application for Employment

Dean Brothers Inc. is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability or any other characteristic protected by law.

INTRODUCTORY INFORMATION:

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

APPLICANT QUESTIONS:

Type of Work Desired

Desired Hourly Salary

Date Available

YYYY

Confirm The Following

Check all that apply.

I can provide documents required to establish your eligibility to work in the U.S.

I am 16 years of age or older.

I have a valid driver's license.

Have you ever been convicted of, or plead guilty or no contest to, a crime other than a minor traffic violation?

Explain how you were referred to Dean Brothers Inc.

EDUCATION AND TRAINING

High School or Last Grade Completed

Provide Name & Address of School Course of Study Number of Years Completed Degree/Diploma

College or Technical School

Provide Name & Address of School Course of Study Number of Years Completed Degree/Diploma

Other Schooling or Training

Provide Name & Address of School Course of Study Number of Years Completed Degree/Diploma

Military Experience

Provide Branch of Service Time of Service Rank/Type of Service Job-Related Training/Experience

EMPLOYMENT HISTORY

Employer Name

Supervisor Name

First Name

Last Name

Employer Phone Number

(###)

###

####

Job Duties and Other Information

Provide your Position Title Summary of Duties Salary upon Leaving Reason for Leaving

Dates Employed

Employer Name

Supervisor Name

First Name

Last Name

Employer Phone Number

(###)

###

####

Job Duties and Other Information

Provide your Position Title Summary of Duties Salary upon Leaving Reason for Leaving

Dates Employed

WORK-RELATED REFERENCES

Reference 1

Provide Name Occupation Years Known Contact Information

Reference 2

Provide Name Occupation Years Known Contact Information

Reference 3

Provide Name Occupation Years Known Contact Information

Statement Agreement

I understand that employment with Dean Brothers is at-will, meaning that I or Dean Brothers may terminate my employment at any time, or for any reason consistent with applicable state or federal law. I authorize Dean Brothers to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I hereby release Dean Brothers, and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information. I understand that Dean Brothers requires the successful completion of a drug and/or alcohol test as a condition of employment. I understand this application will be active for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.

OFFICE PERSONNEL USE ONLY

***DO NOT FILL OUT THIS SECTION*** ***INTERNAL USE ONLY***

Name of Interviewer and Date of Interview

Start Date (if applicable) and Rate of Pay

Division, Classification, and Benefits