Which location are you interested in seeking employment? —Please choose an option—Akron PlantCarbon PlantMilan PlantAny Location Full Name: Present Address: StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming How long have you lived at current address? Phone Number: Are you legally eligible for work in the US? (Yes/No) Social Security Number: Previous Address: StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming How long did you live at previous address? Are you a U.S. Citizen? (Yes/No) Are you at least 18 years of age? (Yes/No) EMPLOYMENT DESIRED Position: Desired salary per hour/per week: Name of Individual(s) What type of work do you enjoy the most? Type of inside work preferred Are there any experiences, skills or qualifications which you feel would especially fit you for work with Pike? Were you previously employed by us? (Yes/No) If yes, in what capacity? Date you can start: How did you hear about us? Are you available to work: Full TimeNightHolidaysPart TimeSummer Only What type of work do you dislike the most? Type of outside work preferred Have you ever applied here before? (Yes/No) If yes, when For which position have you previously applied? RECORD OF EDUCATION Type of School Name and Location Years Attended Diploma/Degree Subject Studied High School College Post Grad Trade, Bus, Corresp. Please list any additional education, training or experience not listed above: MILITARY SERVICE Have you ever served in the Armed Forces? What Branch? List duties and special training: PERSONAL REFERENCES (Individuals not related to you or previous employers who have known you for at least one year.) Name Address Phone Number PRIOR WORK HISTORY (List in order, last or present employer first) EMPLOYER #1 May we contact this employer?YesNo Name, Address & Phone # of Employer Supervisor’s Name and Title Start Date End Date Starting Pay Ending Pay Reason for Leaving Describe in detail the work you did: EMPLOYER #2 May we contact this employer?YesNo Name, Address & Phone # of Employer Supervisor’s Name and Title Start Date End Date Starting Pay Ending Pay Reason for Leaving Describe in detail the work you did: EMPLOYER #3 May we contact this employer?YesNo Name, Address & Phone # of Employer Supervisor’s Name and Title Start Date End Date Starting Pay Ending Pay Reason for Leaving Describe in detail the work you did: In case of emergency, notify: Address: Phone #: Occasionally an application blank makes it difficult for an individual to adequately summarize their complete background. To assist us in finding the proper position for you in our company, use the space below to summarize any additional information necessary to describe your full qualifications. Applicant’s Certification Agreement I authorize the investigation of all statements contained in this application, resume and any attachments. I release from liability any persons or employers supplying such information. I also release the company from all liability that might result from making the investigation. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on the application, resume and any attachments (or on any required document) will be cause for denial of employment or immediate termination of employment, regardless of when or how it was discovered. I agree, if I am offered and accept a position, to conform to all existing and future company rules and regulations, and I understand that the company reserves the right to change wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, WHICH MEANS THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON. I understand that any employment offer is contingent upon my providing, within three working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986. I understand that any employment offer is also contingent upon the passing of a blood and/ or urine test for alcohol and drugs. Pike Lumber will not hire any applicant who fails to pass the pre-employment drug and alcohol test. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment, I certify that all the information provided by me, including any resumes, test answers or attachments, is truthful and accurate. Initials: Date:
