Poulin Design Center Employment Application Application for EmploymentIt is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, or other protected classification.Please enable JavaScript in your browser to complete this form.Name: *Date: *Address: *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTelephone: *Email Address: *Are you over 18 years old? *YesNoAre you authorized to work in the U.S. on an unrestricted basis? *YesNoHave you worked here before? *YesNoHow did you hear about the position/our company?Are you willing to work overtime as required? *YesNoEducationalEducation *High SchoolCollege/UniversityOther training/education High School:Name & Location *Year Graduated *Major *Diploma / Degree *College / University:Name & Location *Year Graduated *Major *Diploma / Degree *Other Training/EducationName & Location *Year Graduated *Major *Diploma / Degree *In addition to your work history, what other expectations, skills or qualifications would make you a good fit to work with our company? *PositionPosition(s) Applied For: *Wage or Salary Desired $: *Date You Can Start: *Days Available: *MTWThFSSunWork HistoryMay we contact your present employer? *YesNoEmployment History(1) Most Recent Employer:(1) Most Recent Employer: *Address *Telephone *Date Started *Starting Salary *Starting PositionDate Left *Salary on Leaving *Position on Leaving *Description of Duties: *Name & Title of Supervisor *Reason for Leaving *(2) Previous Employer:(2) Previous Employer *Address *Telephone *Date Started *Starting Salary *Starting PositionDate Left *Salary on Leaving *Position on Leaving *Description of Duties *Name & Title of Supervisor *Reason for Leaving *(3) Previous Employer:(3) Previous Employer *Address *Telephone *Date Started *Starting Salary *Starting PositionDate Left *Salary on Leaving *Position on Leaving *Description of Duties *Name & Title of Supervisor *Reason for Leaving *Resume:Upload Your Resumepdf,PDF,DOCX,docx,DOC,docApplicant Certification and Agreement I certify that the facts set forth in this application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Company to make an investigation of any of the facts set forth in this application. I understand that the employer may give me a conditional job offer, following which I may be required to finish information regarding medical condition and history and any information regarding any pre-exsisting permanent physical impairment. I further understand that once given a conditional job offer, I will be required to submit to pre-employment testing for the illegal use of drugs.Applicant Signature: *Clear SignatureDate: *MessageSubmit
