Application for Employment

Dunn Paper is an Equal Opportunity Employer

Today’s Date: ______

Name / Social Security Number
Address: Street / City / State / Zip / Phone
( )
Position applying for: / Date available for work:
Have you been employed by DP before? Yes No / When? / Where?
Are you available to work: Full-time? Part-time? On shifts?
Can you provide proof of your identity and legal authority to work in the United States? Yes No
If no, please explain.
Are you under 18 years of age? Yes No / Are you willing to work overtime? Yes No
Are you willing to relocate? Yes No
Have you ever been convicted of any felonies? Yes No If yes, please complete details below. (A prior conviction will not necessarily disqualify you from consideration for employment).
Nature of Crime: Date: City/State: .
Minimum salary requirement $ Per .

RECORD OF EDUCATION

Name, City, State / Major/Degree / Graduated/Completed
Yes No
High School or GED
College or
University
Graduate/
TechnicalSchool
Professional Designations & Licenses
Special Skills: List any experience, skills or other qualifications, which you believe should be considered in evaluating your qualifications for employment (Ex: CDL, Forklift).

EMPLOYMENT HISTORY

LIST PAST EMPLOYMENT BEGINNING WITH YOUR MOST RECENT JOB.

Employer’s Name: / Dates: From to
Address / Telephone Number / Current salary $ per
Type of Business: Job Title:
Duties:
Reason for Leaving: / Last Supervisor’s Name
If currently employed: My current employer may be contacted Yes / No
Employer’s Name: / Dates: From to
Address / Telephone Number / Last salary $ per
Type of Business: Job Title:
Duties:
Reason for Leaving: / Last Supervisor’s Name
Employer’s Name: / Dates: From to
Address / Telephone Number / Last salary $ per
Type of Business: Job Title:
Duties:
Reason for Leaving: / Last Supervisor’s Name

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered without regard to race, color, religion, sex, sexual orientation, age, marital status, national origin, citizenship status or disability, veteran status or any other protected category.

REFERENCES

List three employment or school references that Dunn Paper has permission to contact.

All names and addresses should be complete including initials, street names, zip codes, etc.

Name / Street Address / City / State / Zip Code / Telephone No. / Occupation / Years Known

AGREEMENT AND AUTHORIZATION

PLEASE READ CAREFULLY

I understand that, if employed, I will be bound by all policies, work rules, and regulations, the terms and conditions of which may be changed without notice to me. Initial

I certify that all the information provided in this application and any attached resume is true and correct. I authorize Dunn Paper to investigate any statement in this application, or my resume and to investigate my background generally, and I agree that if, in the opinion of Dunn Paper Company I have made any misrepresentation or the results of the investigation are not satisfactory for any reason, any offer of employment may be terminated or I may be discharged after hire without liability except for payment, at the rate agreed upon, for services actually rendered. Initial

I hereby authorize any person, education institution, company or corporation to give any pertinent information to Dunn Paper. Also, if offered a position, I am willing to have a pre-employment urinalysis test for the presence of drugs or alcohol, realizing my initial employment is contingent upon passing the urinalysis test.

Initial

By my signature below I authorize any city, county, state or federal law enforcement agency or court to release to Dunn Paper any record of felonious convictions and I fully release Dunn Paper and any person or public and private entity from any and all liability as a result of providing or verifying information in connection with Dunn Paper’s investigation of my background. Initial

Signature Date Application Completed

Revised 12/05