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S. R. PERROTT, INC.
1280 N. U.S. Highway 1
Ormond Beach, FL 32176
(386) 672-2275
APPLICATION FOR EMPLOYMENT
How Long Have You Lived At Your Present Address?
If Less than 3 Years, List All Previous Addresses Below
Referred By:
Radio
Employment Agency
Friend
Relative
No One
Are you legally eligible for permanent employment in the United States? (If hired, law will require verification)
Yes
No
Are you 18 or older?
Yes
No
Position Applied For:
Select one...
MERCHANDISER
OFF-PREMISE SALES DEPARTMENT
DRAFT DELIVERY DRIVER
DELIVERY DRIVER
WAREHOUSE
OTHER
Rate of pay expected:
How did you hear about this opening?
Have you worked for us before?
Yes
No
If yes, when?
Indicate special qualifications or skills
PERSONAL INFO
Operators / CDL: There is a cost for our CDL Training Course if you need to upgrade your license class. Please provide your Driver's License Number, Class and State Issued.
N/A
Traffic Tickets?
Yes
No
EDUCATION
Elementary School
High School
Did You Graduate High School?
Yes
No
N/A
College
Course of Study
Did You Graduate College?
Yes
No
N/A
Other
Course of Study
ReferenceS
Personal
Professional
Uniform Sizes
Shirts
Select one...
Small
Medium
Large
XLarge
XXLarge
Pants
Name to Put on Shirt
Previous Employment
Employer 1 (*REQUIRED)
Employer 2
Employer 3
Additional Driving Experience
Straight Truck
N/A
Tractor Trailer
N/A
Other
N/A
Military
N/A
The above information is true and complete to the best of my knowledge. Should the Company employ me, and misrepresentations or false statement contained herein may be considered cause for possible dismissal. The Company has my permission to obtain all necessary information from the references I have listed, or any other sources concerning my prior employment, personal history or credit standing and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice to me. I reserve the right to know the names and addresses of any investigative agencies used in order that I may learn the information contained in any reports furnished to the Company.
I understand this application does not constitute an employment contract of any kind. Should the Company employ me, I may resign such employment at any time at my discretion with or without prior notice and the Company may terminate my employment at any time at their discretion, with or without prior notice.
If a job position is offered, I realize I must submit to and pass a pre-employment physical and urinalysis drug screen for my employment to continue, the cost of which will be deducted from my medical reimbursement account when I become eligible for it. I further acknowledge that should my employment end prior to the eligibility for my medical reimbursement benefits, either voluntarily or involuntarily, the cost of my pre-employment testing will be deducted from my final paycheck.
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Misrepresentation on my physical exam will be grounds for dismissal.
EOE/DFWP
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