Application for Employment

(Pre-Employment Questionnaire)

Brookside Equipment Sales Inc. is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

Personal

Last, First, Middle:

Date:

Other Name(s) Used:

Social Security #:

Present Address:

Telephone #:

Permanent Address:

Alternate Telephone #:

Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Yes  No

Are you at least 18 years old?  Yes No

Have you ever been convicted of a felony  Yes  No         If yes please explain:

Employment Desired

Position:

Date You Can Start

Are You Employed Now?  Yes  No

If yes, may we inquire of your present employer(s)?  Yes No

Have you ever interviewed with Brookside Equipment Sales before?  Yes  No

If yes, list date(s), & location(s)

Have you ever been employed by the Brookside Equipment Sales before?  Yes No

If yes, list date(s), job title(s) & location(s)

Salary Desired:

Referred By:

Education

School

Name and Location of School

Degree, Diploma,

License or Certificate

Major Studies

GPA

High School:

 

 

  

 

 

College/University:

 

 

 

 

  

 

 

Vocational, Business, Other:

 

 

 

 

  

 

 

Subjects of Special Study:

Special Skills or Qualifications:

Activities (Civic, Athletic, Etc.):

 

U.S. Military  Yes No

Rank:

Present Membership in National Guard or Reserves Yes No

Computer Skills (Hardware/Software)

Employment History

List below the last three, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.

Employed From

       /        /

Employer Name

Supervisor Name

Starting Salary

Employed Until

       /        /

Employer Address

Supervisor Phone #

Ending Salary

Job Title

Reason for Leaving

Duties & Responsibilities

Employed From

          /        /

Employer Name

Supervisor Name

Starting Salary

Employed Until

          /        /

Employer Address

Supervisor Phone #

Ending Salary

Job Title

Reason for Leaving

Duties & Responsibilities

Employed From

          /        /

Employer Name

Supervisor Name

Starting Salary

Employed Until

          /        /

Employer Address

Supervisor Phone #

Ending Salary

Job Title

 

Reason for Leaving

Duties & Responsibilities:

Which of These Jobs Did you Like The Best?

What Did You Like Most About This Job?

References

Name

Address

Business

Years Acquainted

 

 

 

  

 

 

 

 

 

  

 

 

 

 

 

  

In Case of Emergency Notify:

 

 

 

 

Certification & Authorization

In order to be considered for employment you will need to complete and sign the Application for Employment above and sign the acknowledgment at the bottom of this form.  Please read this carefully before submitting your application.

 

In order to be considered for employment you will need to complete and sign the Authorization to Release Information above and sign the acknowledgment at the bottom of this form.  Please read this carefully before submitting your application.

 

Brookside Equipment Sales requires pre-employment drug tests and physicals for all new hires.  Please be aware that if you are offered a position with Brookside Equipment Sales Inc., You will be required to take the post-offer physical and drug screen at the health provider designated by Brookside Equipment Sales.  However, should a follow-up visit or drug screen become necessary to verify eligibility for employment, subsequent visits will be at the applicant's expense.

 

Should you be offered a position with Brookside Equipment Sales, you will be informed of the hours you will be required to work in that position.  However, Brookside Equipment Sales reserves the right to change its operating hours as deemed necessary.  You may also be required to work overtime when considered necessary by your supervisor.

 

Nothing in this application, or in any prior or subsequent written or oral statements, creates a contract of employment.  If hired by Brookside Equipment Sales Inc., your employment will be at-will, for an indefinite period of time, and may be terminated at any time by Brookside Equipment Sales, Inc. or yourself.  You have the right to end your employment at any time without cause or notice, and Brookside Equipment Sales retains that same right.

 

"The above information is true and correct. I understand that the hiring process will be terminated, or in the event of my employment by the Company, I shall be subject to dismissal, if any information that I have given in this application, the background release form, in any resume or interview or any part of the hiring process is false or misleading or if I have failed to give any information herein requested, or if I have withheld relevant information, regardless of the time elapsed after discovery.

I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit and consumer check.  I understand that that the Company will provide a separate Disclosure and Release required by law that will permit the Company to make such inquires through the services of a third party.

 

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing."

 

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.

 

I hereby authorize my prior employer, to release any and all information relating to my employment with them to Brookside Equipment Sales, Inc. . I further release and hold harmless both my prior employer and Brookside Equipment Sales Inc. from any and all liability that may potentially result from the release and/or use of such information. I understand that any information released by my prior employer will be held in strictest confidence, that it will be viewed only by those involved in the hiring decision, and that neither I nor anyone else not so involved will have the right to see the information.

 

I hereby acknowledge that I have read and agree to the above statements.

Signature of Applicant

 

Date

Upon Completion Fax: 713-943-9102

Attention: Lisa Bielamowicz