Tippen's Specialty Millwork, Inc

211 Hood St., West Monroe, La 71292
(Phone 318-387-5973, Fax 318-387-4863)

Application for Employment - We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including, race, color, age, sex, religion, disability or national origin.  Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process.

APPLICANT INFORMATION

Last Name    First   MI   Date
Street Address Apartment/Unit #
City State Zip
Phone Email Address
Date Available Social Security No.  
Desired Salary Position Applied For

Are you a citizen of the United States? yes no                                                      If no, are you authorized to work in the U.S.? yes no

Have you ever worked for this company? yes no                                                                                 If so, when?

Have you been convicted of a felony? yes no                                   If yes, Explain

EDUCATION

High School Address
From To                                                                                   Did you Graduate? yes no

College Address
From To                                                                                   Did you Graduate? yes no
Degree

Other Address
From To                                                                                   Did you Graduate? yes no
Degree

REFERENCES - PLEASE LIST 3 PROFESSIONAL REFERENCES

Full Name Relationship
Company Phone
Address

Full Name Relationship
Company Phone
Address

Full Name Relationship
Company Phone
Address

PREVIOUS EMPLOYMENT

Company Phone

Address Supervisor Responsibilities
Job Title Starting Salary Ending Salary

From To Reason for Leaving
May we contact you previous employer for a reference? yes no

Company Phone

Address Supervisor Responsibilities
Job Title Starting Salary Ending Salary

From To Reason for Leaving
May we contact you previous employer for a reference? yes no

Company Phone

Address Supervisor Responsibilities
Job Title Starting Salary Ending Salary

From To Reason for Leaving
May we contact you previous employer for a reference? yes no

MILITARY SERVICE

Branch From To
Rank at Discharge Type of Discharge

If other that honorable, please explain

DISCLAIMER AND SIGNATURE

I certify that my answers are try and complete to the best of my knowledge.  If this application leads to employment, I understand that false of misleading information in my application or interview may result in my release.
I understand that I will be required to submit to a pre-employment drug test.  The cost of this drug test will be deducted from my first paycheck.  Upon completion of 3 months of service, the amount of the drug test will be refunded to me.
I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire.  If hired I agree to abide by all Company work rules, policies, and procedures.  The Company retains the right to revise its policies or procedures in whole or part at any time.

Signature Date