Employment Application

Deals Glass Services is an equal opportunity employer dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

Personal Information

First Name*:
Last Name*:

Present Street Address:
City*:
State*:
Zip Code:
Email Address*:
Telephone Number:
Position Applied For:

Do you have any relatives who are presently (or have formerly been) employed by Deals Glass Services? If so please provide name(s):
How were you referred to the company?
Have you ever been convicted of a felony: Yes No If yes, please explain:

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Education History

Please select all levels of education completed and provide name of institution in boxes below:

	High School
	College
	Tech Training
	Other

Employment Record

Please include all employment for the past five years, starting with the most recent employer:

Company Name:
City/State:
Phone:
Position held:
Dates Employed:
Manager/Supervisor:
Wage/Salary:
Reason for Leaving:

Company Name:
City/State:
Phone:
Position held:
Dates Employed:
Manager/Supervisor:
Wage/Salary:
Reason for Leaving:

Company Name:
City/State:
Phone:
Position held:
Dates Employed:
Manager/Supervisor:
Wage/Salary:
Reason for Leaving:

Company Name:
City/State:
Phone:
Position held:
Dates Employed:
Manager/Supervisor:
Wage/Salary:
Reason for Leaving:

Company Name:
City/State:
Phone:
Position held:
Dates Employed:
Manager/Supervisor:
Wage/Salary:
Reason for Leaving:

References

Please do not include relatives or former employees.

Name:
Address:
Phone:
Occupation:
Years known:

Name:
Address:
Phone:
Occupation:
Years known:

Name:
Address:
Phone:
Occupation:
Years known:

Work Availability

If your application receives favorable consideration, when will you be available to begin work?

Please check which of the following applies to you:

No objection to working overtime
Can work overtime without prior notice
Can work on Saturdays
Can work on Sundays
Can travel if required by this position

Salary/Hourly Requirements

If your application receives favorable consideration, what salary/hourly rate would you require? Please specify below:

Any Additional Comments: