EmailMe Form - Koopman Lumber Employment

PERSONAL INFORMATION

>>>Please note - at the end of the form, ONLY CLICK SUBMIT ONE TIME. It may take up to a minute to acknowledge your submittal.

Name: *

First Middle Last

Phone: *

### - ### - ####

Email *

Confirm

Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

If under 18 years of age can you provide a work permit if required?

Yes

No

Are you legally authorized to work in the United States? *

Yes

No

You will be required to furnish proof of lawful work status if you are extended a job offer in accordance with the Immigration Reform and Control Act of 1986.

EMPLOYMENT DESIRED

What store location are you applying for? *

Are you applying for a specific job posting? *

Yes

No

Position(s) Interested In: *

If you chose "Other" please describe:

Available Start Date: *

MM / DD / YYYY

Availability: *

Full Time

Part Time

Either

What days are you available to work? *

Salary/Wage Request: *

This is not a guaranteed amount.

Referred By: (if applicable)

Have you ever worked for Koopman Lumber before?

Yes

No

If so, when?

Will you be holding any other jobs while employed by Koopman Lumber?

Yes

No

If so, please describe:

Are you prohibited from, or limited in, your performance of any job duties for Koopman Lumber by any restrictive covenants not to compete, confidentiality agreements, or any other contracted obligations?

Yes

No

If you answered "Yes" to the above question, please upload a copy of the agreement here, or provide a copy to our Human Resources office.

EDUCATION

Highest Grade School Grade Completed:

Highest High School Grade Completed:

Highest College Year Completed:

Last school attended name:

License, Vocation, or Trade Training:

SKILL AND QUALIFICATIONS

Summarize any special training, skills, licensing, and/or certificates that may assist you in performing the position for which you are applying:

If applying for a driver position, please list all current licenses and certifications:

EMPLOYMENT HISTORY

Please list employment history here, even if attaching résumé.

List below your work experience (starting with your present or most recent employer) for the last five years or your last three employers, whichever will provide us with the greatest information about you. You may include as part of your employment history any verified work performed on a volunteer basis. Please account for all periods of unemployment in this section.

	Dates Employed (From/To)	Name/Address of Employer	Supervisor Name	Position Held	Reason for Leaving
1

	Dates Employed (From/To)	Name/Address of Employer	Supervisor Name	Position Held	Reason for Leaving
2
3
4
5

May we contact your present employer?

Yes

No

Which of these jobs did you like best?

What did you like most about this job?

Please Upload your Résumé Here:

Additional upload for your Résumé:

REFERENCES

Please list three

	Name	Occupation	Phone
1
2
3

If you were referred to apply by a Koopman employee, please list them here:

As it pertains to potential employment at Koopman Lumber, tell us a little about yourself and why you're interested in joining the Koopman Lumber team?

What type of position(s) or work are you most interested in?

APPLICANT'S STATEMENT

I have read and fully understand the questions asked in this application. I understand that this application is not an offer or contract of employment. If hired, I understand that any employment will be on a 90-day introductory basis and that may employment may be terminated with or without cause or notice, at any time, at either my option or that of Koopman Lumber. I understand that no management representative has any authority to enter into any agreement for continuing employment for any specific period of time or which is contrary to the foregoing without a written agreement signed by an owner and me. I give Koopman Lumber permission to contact all or any of my previous employers and references and authorize them to provide all information requested of them by Koopman Lumber, and release and hold harmless all persons and entities from liability for doing so. After a tentative offer of employment has been made, if requested by Koopman Lumber, I agree to take a physical examination at no personal expense and authorize the examining physician to disclose the findings to Koopman Lumber. I also agree to take a drug test and authorize the testing facility to disclose the findings to Koopman Lumber. I understand that any offer of employment is conditioned upon receipt of passing the drug test, satisfactory references and satisfactory completion of such physical examination.
I have provided truthful and complete responses to all inquiries in the application and understand that the discovery of any falsification or omission constitutes a ground for immediate dismissal.

Signature: *

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