Application for Employment










Referral Source

Employee Referral
Government Agency
Community Organization
Walk In
Job Fair
Newspaper Ad
School
Other

Area of Interest



1st Shift 2nd Shift 3rd Shift
Are you at least 18 years of age?
Yes No
Have you ever worked for Dietz & Watson before?
Yes No



Have you previously applied at Dietz & Watson within the past year?
Yes No

Eligibility

If hired, can you provide proof that you are eligible to work in the United States for Dietz & Watson?
Yes No
Have you ever been convicted of a crime?
Yes No
If yes, please provide the Date, Type of Offense, and the name and location of the court.

Note: A conviction does not automatically disqualify you from consideration. The nature of the offense, date of conviction, work history and other job-relates qualifications will be considered in making our decision.

Is there any reason that will interfere with your ability to have excellent attendance and be on time for work?
Yes No
If yes, please explain.

Are you willing to work overtime if necessary?
Yes No
Are you willing to work weekends and/or holidays if necessary?
Yes No
Are you willing to work any shift, if applicable?
Yes No
If not, what hours are you unable to work?

Education

Please describe your education, include the name & location of the school. List high school, college or trade school if applicable.

Employment History

Please list your job history starting with your present or most recent job (includign military service). Please include company name and address, phone number, start and end dates, pay rate, position, reason for leaving and your immediate supervisor.

References

Please provide the names of three persons not related to you, whom you have know at least one year.


Notice to All Applicants

Complete responses to each item must be supplied or the application may not be considered.

The information supplied on the application must be true and complete. Any deliberate falsifications, misrepresentations or omissions of fact may be grounds for rejection of my application or dismissal from subsequent employment

Nothing in this application is intended to imply or create an employment relationship or contract for employment. If hired, employment is at-will and can be terminated at any time, with or without notice, for any reason.

Employment with Black Bear Distribution LLC may be contingent upon the applicant passing a criminal background check, physical examination and/or drug-screening test. The physical examination and drug-screening test will be administered at a time and place specified by Black Bear Distribution. Black Bear Distribution has the right to revoke any offer of employment based on the job-related nature of a conviction, failure of the drug-screen, and/or inability to reasonably accommodate a restriction from the physical examination.

Black Bear Distribution is authorized to investigate all statements made on the application and to discuss the results of its investigations with those responsible for hiring. Black Bear Distribution may contact former employer(s) or other persons who can verify information.

Authorization

I have read and agree to the conditions stated above. I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.