Referral Source*

Position(s) Applied for*

Desired Pay

Date of Application*

Last Name*

First Name*, Middle Name

Street Address*

City*

State*

Zip Code*

Email Address*

Telephone Number*

Are you 18 years of age or older?*

Have you filed an application with us previously?*

If yes, what was the date of your previous application?

Have you ever been employed by Wayne Automatic Fire Sprinklers?*

If yes, please give dates of employment.

Can you, if employed, submit verification of your right to work in the United States?*

Date you will be available for work?*

Type of Employment desired?*

Can you work out of town for extended periods of time if the job requires it?*

Are you willing to relocate if the job requires it?*

Will you work overtime if the job requires it?*

Have you been convicted of a Misdemeanor and/or felony?*

If yes, please provide your conviction date and explain: (A conviction will not necessarily be a bar to employment with Wayne Automatic Sprinklers. Factors such as the age, nature and severity of the offense will be taken into account.)

Have you ever been a party to a civil law suit? * If yes, explain below.

Please list any certificates or licenses you hold, or specialized training you have completed, or equipment you have operated which may qualify you for employment in the automatic fire sprinkler industry in the space below.

Please answer the following questions only if you are applying for a job which may require operation of a company vehicle.

Do you have a valid driver's license?

Driver's License Number

State

Has you license ever been revoked or suspended? If yes, please give date(s), location(s) and reason(s) in space below.

Name/Loc. High School or type GED

No. Yrs

Degree

Course of Study

Name and Location of College

No. Yrs

Degree

Course of Study

Name and Location of Grad School

No. Yrs

Degree

Course of Study

Technical or Vocational School

No. Yrs

Degree

Course of Study

Employer (most recent)*

Telephone Number

Street Address

Dates Employed* From - To

City*

State*

Zip Code

Job Title

Immediate Supervisor

Reason for Leaving

Hourly Rate or Salary*

May we contact this employer for the purpose of obtaining a job reference?

Summarize your job responsibilities.

Employer 2*

Telephone Number

Street Address

Dates Employed* From - To

City*

State*

Zip Code

Job Title

Immediate Supervisor

Reason for Leaving

Hourly Rate or Salary*

May we contact this employer for the purpose of obtaining a job reference?

Summarize your job responsibilities.

Employer 3

Telephone Number

Street Address

Dates Employed From - To

City

State

Zip Code

Job Title

Immediate Supervisor

Reason for Leaving

Hourly Rate or Salary*

May we contact this employer for the purpose of obtaining a job reference?

Summarize your job responsibilities.

*By clicking acceptance button above, I hereby authorize investigation of all statements contained in this application for employment. If I am employed by Wayne Automatic Fire Sprinklers, I understand that false of misleading information given in this application or in subsequent interviews may result in my termination. Further, I understand Wayne Automatic Fire Sprinklers reserves the right to terminate my employment at any time, with or without prior notice or cause. I understand that only the company President has the authority to make any assurances to the contrary. This application is considered by Wayne Automatic Fire Sprinklers as current for thirty (30) days. After that time, it will be necessary for me to fill out a new application if I still wish to be considered for employment. Wayne Automatic Fire Sprinklers is an equal opportunity employer. If invited for an interview, I further understand that I will be asked to sign two forms: 1. "Applicant authorization and consent for release of information" and 2. "PRE-EMPLOYMENT DRUG TESTING CONSENT AND RELEASE FORM."