Employment | Duval Glass

Date of Application*
Your Name?*
First Last
Your Home Address?*
Street Address Apt - Suite Number City State ZIP Code
Your Phone Please?*
Please enter the best number to reach you.
Your Email Address?
Enter Email Confirm Email
Please click next to move foward....

Are you a U.S. Citizen?*
- Yes
- No
Have you ever been convicted of a Felony?*
- Yes
- No
If selected for employment, are you willing to submit to a pre-employment drug screening test?*
- Yes
- No
Next, Position Application

Position
Position your Applying for?*
Available Start Date*
Your desired pay?*
Employment Desired?*
- Full Time
- Part Time
Next is Education..

School Name, Location, Years Attended, Degree Received, Major*
Please fill out as best as you can?
Do you have another Education Entry?*
- Yes
- No
School Name, Location, Years Attended, Degree Received, Major*
Please fill out as best as you can?
Do you have another Education Entry?*
- Yes
- No
School Name, Location, Years Attended, Degree Received, Major*
Please fill out as best as you can?
Next is References...

References
Name, Title, Company, Phone Number*
Please fill in this area as best as you can.
Do you have another reference?*
- Yes
- No
Name, Title, Company, Phone Number*
Please fill in this area as best as you can.
Do you have another reference?*
- Yes
- No
Name, Title, Company, Phone Number*
Please fill in this area as best as you can.
Next is Employment History...

Employment History
Company Name*
First
Work Phone*
Employer Address*
Street Address Address Line 2 City State ZIP Code
Date Employed*
Please fill out the starting and ending date of employment
Starting and Ending Pay Rate*
Please fill out the starting and ending rate of your pay or salary
Do you have another employer to enter?*
- Yes
- No
Company Name*
First
Work Phone*
Employer Address*
Street Address Address Line 2 City State ZIP Code
Date Employed*
Please fill out the starting and ending date of employment
Starting and Ending Pay Rate*
Please fill out the starting and ending rate of your pay or salary
Do you have another employer to enter?*
- Yes
- No
Company Name*
First
Work Phone*
Employer Address*
Street Address Address Line 2 City State ZIP Code
Date Employed*
Please fill out the starting and ending date of employment
Starting and Ending Pay Rate*
Please fill out the starting and ending rate of your pay or salary
That's It! Next is to certify and sign...

I certify
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed; falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal; and state laws. I understand that a consumer credit report, criminal records check or drug screen may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.” In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility document form upon hire.
Signature Disclaimer
By entering in my first and last name along with the date I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Name*
First Last
Date*
Phone
This field is for validation purposes and should be left unchanged.

Step 1 of 7

Please click next to move foward....

Next, Position Application

Position

Next is Education..

Next is References...

References

Next is Employment History...

Employment History

That's It! Next is to certify and sign...

I certify

Signature Disclaimer