Kent's Supply Center, Inc.
Employment Application

First Name		Last Name
Provide other names:
Social Security Number
Date

Street Address
Address (cont.)
City
State/Province	Zip/Postal Code
Message Phone	Home Phone

  I am available for employment on a 

Temporary Basis
Regular Basis
Part Time Basis

Are you willing to work overtime if required?

Yes No

Are you willing to work weekends?

Yes No

Date Available?

Salary Desired?

Referred by:

Name

Name(s) & Relationship(s) of Relatives Employed by Kents:

 EDUCATION:

High School/GED and Location

Select Last Year Completed:

1
2
3
4

Major or Minor Subjects:

Degree or Credits:

GPA:

College:

Circle Last Year Completed:

1
2
3
4

Major or Minor Subjects:

Degree or Credits:

GPA:

Trade or Business School

Circle Last Year Completed:

1
2
3
4

Major or Minor Subjects

Degree or Credits

GPA:

Other:

EMPLOYMENT HISTORY: Beginning with your present or last position, list the last four jobs you have held, including a summary of major duties and responsibilities (indicate military experience if job related). 

Name of Employer:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Dates Employed	From To
Starting Title
Last Title
Starting Salary	Ending Salary
Name of Supervisor
May we contact now?    Yes No	Reason for Leaving:
Brief Description of Duties:

Name of Employer:

Are you a U.S. Citizen?

Yes No

If you are not a U.S. Citizen or permanent resident of the U.S., please provide alien work permit number:

Have you ever been convicted of: (1) A misdemeanor, gross misdemeanor or felony (excluding juvenile adjudication)?

Yes No

(2) A moving traffic violation within the last five years?

Yes No

If yes, attach statement giving date(s), time(s), location(s), circumstance(s), and dollar amount of fine(s). Include any condition of your parole and/or probation, if applicable. Moving traffic violations will only be considered if driving a vehicle is a requirement. A criminal conviction is not an automatic bar to employment. Each case is considered on its individual merits. LACK OF REQUESTED INFORMATION IS BASIS FOR REJECTING AN APPLICATION.

Please use space provided below to list additional qualifications or information you feel would be helpful in considering your application:

REFERENCES: List three persons not related to you, whom you have known at least one year. All information will be held in strict confidence.

First Name
Last Name
Organization
Street Address
City
State/Province
Zip/Postal Code
Work Phone
Years Known

Signature and Date

KENT'S SUPPLY CENTER, INC.
DRUG TESTING PROGRAM

Kent's Supply Center, Inc. has a vital interest in maintaining safe, healthful and efficient working conditions for its customers and employees. Using or being under the influence of drugs and/or alcohol on the job may pose serious safety and health risks not only for the user, but also to the public and all those who work with the user. The possession, use or sale of an illegal drug or controlled substance may also pose unacceptable risks to safe, healthful and efficient operations.  To meet this compelling interest, individuals who wish to be considered for employment must agree to DRUG AND ALCOHOL TESTING DURING EMPLOYMENT. By completing and signing this Notice and the above Application of Employment, the applicant understands and agrees to submit to drug and alcohol testing during the course of employment as provided for in Kent's Supply Center, Inc.'s Drug and Alcohol Policy. The applicant further understands and agrees to release Kent's Supply Center, Inc. and its directors, officers, agents, employees, parents, subsidiaries and affiliated concerns from any and all liability, claims, demands, damages and causes of action of every kind and nature arising out of or resulting from or in connection with submitting to drug and alcohol testing and any decision concerning employment made by Kent's Supply Center, Inc. in a whole or in part, based upon the results of drug and alcohol testing. Submission of an altered or adulterated specimen or the substitution of a specimen by the applicant will result in a withdrawal of the employment offer.  ANY APPLICANT WHO IS UNWILLING TO AGREE TO THESE CONDITIONS SHOULD NOT APPLY FOR EMPLOYMENT WITH KENT'S SUPPLY CENTER, INC.

Signature and Date