Application for Employment

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You can download the application for employment and fax it to Robert Stahmann at 866-560-6593, or fill out the form below. Someone will contact you regarding your inquiry.

Application for Employment (check one)

Distribution Specialist (delivery)

Color Specialist

Sales Associate (counter sales)

Outside Sales Associate

Warehouse Assistant

Manager

Administrative Assistant

Other (please describe)

Status
Full time	Part time

Date available to work

Ben's Paint Supply is an equal opportunity employer. We consider applicants for all positions on the basis of qualifications only and without regard to race, color, religion, sex, national origin, age, marital status, veteran status, disability, sexual orientation, use of lawful products during non-work hours and any other legally protected status.

Personal Information (please print)

Driver's License No.

Is your Driver's License a CDL?

Yes No

If so, what Class?

A B C

If C, HazMat endorsed?

Yes No

(Note: A Commercial Driver's License is NOT normally a requirement for employment)

State

Social Security No.

(Not mandatory, but will be requested for background check pre-hire if you become a finalist for the position)

First Name

Last Name

Physical Address:

Mailing Address (if different):

Contact Information

Home phone:

Cell:

Emergency phone:

E-mail:

Are you currently employed?

Yes No

If yes, may we contact your present employer for references?

Yes No

Are you legally qualified to work in the United States? (proof of citizenship or immigration status will be required upon employment)

Yes No

Have you ever been convicted of a felony?

Yes No

Are you 18 or older?

Yes No

Have you ever worked under another name?

Yes No

If yes, give name

Are you bilingual?

Yes No

If yes, list second speaking language

Employment Experience (list most recent first)

Employer

Dates employed:

From:

To:

Address

City

State

Phone

Supervisor

Job title

Type of work

Final pay

Reason for Leaving

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Employer

Dates employed:

From:

To:

Address

City

State

Phone

Supervisor

Job title

Type of work

Final pay

Reason for Leaving

Education

High School

High School Name:

High School Location:

Graduated:

Yes No

If yes, when?

College

College Name:

College Location:

College Graduation:

Graduated:

Yes No

If yes, when?

Military, Technical, or Other Education

Please describe

I certify that the answers given herein are true and complete to the best of my knowledge. I also authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In connection with my application for employment and as a condition of continuing employment, I understand that investigative background inquiries may be made on me including previous employers, schools, criminal convictions, motor vehicle and other reports. These reports will include information as to my character, work habits, performance, education, compensation, and experience along with reasons for termination of employment from previous employers. I hereby consent to obtaining the above information from previous employers and other authorized agents. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written documentation or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Employer.

Signature of Applicant:
(Type name if filling out online, which will be considered
as your signature and that you have read and agree
with the above statement)

Date:

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