Employment Application

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WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Email *

GENERALDISTRIBUTINGCOMPANY.COM

Todays Date: *

YYYY

Full Name: First , Middle and Last *

Email Address *

Address (Street Number and Name) *

Address (City, State and Zip)

Home Phone *

Cell Phone *

Which county would you prefer to work in primarily?

Salt Lake and Davis County

Utah County or Central Utah Counties

Tooele County

Summit and Wasatch County

Clear selection

Position Applied for: *

Grocery & Convenience Store Merchandiser (Stocker)

Delivery Driver and Helper

Warehouse

Other

Date Available: *

YYYY

How did you hear about General Distributing? *

Rate of pay desired? *

Do you desire: *

Part Time

Full Time

Either

Are you willing to work any shift? *

Yes

Are you willing to work *

Saturdays

Sundays

Extended Hours

Have you ever been employed by this company before? *

Yes

If “Yes” please indicate dates of employment and positions held:

Indicate name(s) under which you worked for this company (if different from current name):

Do you have any relatives employed by us:

Are you over the age of 21? *

Yes

Other:

Have you ever been convicted of a felony or a “non-traffic” misdemeanor? *

Yes

If “Yes” please fully explain circumstances and provide date(s): *A conviction may not necessarily disqualify an applicant from employment

If applying for a driving position, please provide the following: Drivers License #, Expiration Date and Type(s) *

EDUCATIONAL RECORD: High School Check Last Year Completed *

Graduate

EDUCATIONAL RECORD: College/University Check Last Year Completed

Graduate

Other:

Clear selection

EDUCATIONAL RECORD: Technical School Check Last Year Completed

Graduate

Other:

Clear selection

EDUCATIONAL RECORD: Other School Check Last Year Completed

Graduate

Other:

Clear selection

Military Experience: Were you in the military service? *

Yes

List activities in the service, including special training, that is relevant to the position you are applying for:

EMPLOYMENT HISTORY SECTION:

Begin with the most recent employer and account for the last three (3) jobs. Include any substantial periods of unemployment or schooling.

Employer (1) Name, Address, Phone Number *

Employer (1) Dates of Employment *

Employer (1) Duties *

Employer (1) Salary or Wage *

Employer (1) Reason for Leaving *

Quit

Laid Off

Discharge

Other:

Employer (2) Name, Address, Phone Number

Employer (2) Dates of Employment

Employer (2) Duties

Employer (2) Salary or Wage

Employer (2) Reason for Leaving

Quit

Laid Off

Discharge

Other:

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Employer (3) Name, Address, Phone Number

Employer (3) Dates of Employment

Employer (3) Duties

Employer (3) Salary or Wage

Employer (3) Reason for Leaving

Quit

Laid Off

Discharge

Other:

Clear selection

May we contact your present employer?

Yes

Other

Clear selection

LIST THREE PERSONAL REFERENCES (Do not include relatives or former employees)

Reference (1) Name, Address and Phone Number *

Reference (2) Name, Address and Phone Number *

Reference (3) Name, Address and Phone Number *

LIST PROFESSIONAL TRADE, BUSINESS OR CIVIC ORGANIZATIONS AND ANY OFFICES HELD

(Exclude memberships that would reveal sex, race, religion, national origin, age, ancestry or other protected status.)

Organization (1) Name and Office Held

Organization (2) Name and Office Held

LIST SPECIFIC ACCOMPLISHMENTS, PUBLICATIONS, AWARDS OR ANY ADDITIONAL INFORMATION YOU WOULD LIKE US TO CONSIDER(Exclude anything that would reveal sex, race, religion, national origin, age, ancestry or other protected status.)

PLEASE READ CAREFULLY AND SIGN DIGITALLY BELOW

The information set forth in this application is true, complete and accurate. I understand and agree that if employed, and during such period of employment, any false statements, misrepresentations of facts, or omissions made by myself become known, the Company may terminate my employment immediately.

I hereby authorize the Company and/or its assigns to investigate my personal history and to obtain from my previous employers any information they have concerning me.

The Company may do a comprehensive “background investigation” regarding the accuracy of my employment application, not excluding a Driver’s Record, Financial Inquiry Report and other such investigative inquiries. Inquiries as to my character, general reputation, personal characteristics and work habits will be included and I hereby release and save harmless the Company, their assigns and other institutions/companies and their assigns from any and all liability which might otherwise be incurred by gathering and/or furnishing such information. I understand that a physical examination, drug and alcohol use test, and/or a pre-employment personality/performance profile review may be required.

If employed, I understand that such employment is for no specific duration and may be terminated at any time with or without cause.

Applicant's Digital Signature (Name) *

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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