Job Application

Date of Application:

Position Applied for:*

Telephone #*

Expected Wage:

Name*

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address:*

How were you referred to us?*

Are you related to anyone currently working for North Florida Sales?*

Yes
No

If yes, whom?

Have you ever been employed with North Florida Sales before?*

Yes
No

If yes, position and dates?

ARE YOU AT LEAST 21 YEARS OF AGE / 23 for DRIVER POSITIONS?*

Yes
No

DO YOU HAVE THE LEGAL RIGHT TO WORK IN THE U.S.?*

Yes
No

DO YOU POSSESS A DRIVER’S LICENSE?*

Yes
No

CLASS:*

Driver’s License #:*

(Class A CDL or permit required for ALL Driver positions.)

HAVE YOU EVER BEEN CONVICTED OF A CRIME? If yes, please explain:*

Yes
No

*

(A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. FACTORS SUCH AS JOB RELATIONS, AGE AND TIME OF THE OFFENSE, SERIOUSNESS AND NATURE OF VIOLATION AND REHABILITATION WILL BE TAKEN INTO ACCOUNT.)

DRIVING RECORD:

Please list any traffic convictions or accidents you have had in the last 5 years. Most recent first:

Records

Date

Charge

Points Assessed

Injuries/Fatalities

Location

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EMPLOYMENT EXPERIENCE. Please provide 7 YEARS OF WORK EXPERIENCE, explain any gaps:

Current/ Most Recent Employer:*

Address

Phone #:*

Dates of Employment: From:*

To:*

Supervisor:*

Job Title:*

Salary:*

Reason for leaving:*

Duties:*

Experience

Employer:

Supervisor:

Address:

Phone #:

Reason for leaving:

Dates of Employment: From:

To:

Salary:

Job Title:

Duties:

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ADDITIONAL INFORMATION:

1) Why do you want to become an employee of North Florida Sales?

2) State any additional information you feel may be helpful to us in considering your application. Summarize special job-related skills & qualifications from past employment and other experiences.

In the past 5 years, have you ever been convicted of any of the following motor vehicle violations?

DUI or DWI or Refusal to take an alcohol or drug test*

Yes
No

Reckless driving*

Yes
No

Using a motor vehicle in the commission of a felony*

Yes
No

Hit and run*

Yes
No

Racing on a public road*

Yes
No

Fleeing or attempting to elude a law enforcement officer*

Yes
No

In the past 3 years, have you ever been convicted of any of the following motor vehicle violations?

Aggressive careless driving*

Yes
No

Leaving the scene of an accident that involves injury or damage or both*

Yes
No

Open container of alcohol (operator)*

Yes
No

Permitting an unlicensed person to operate a motor vehicle*

Yes
No

Speeding – 25 mph or more over the posted speed limit*

Yes
No

Driving on a canceled or revoked driver’s license*

Yes
No

Driving a commercial motor vehicle with a disqualified CDL*

Yes
No

List all States where you held a motor vehicle operator’s license within the past five (5) years and PROVIDE THE LICENSE NUMBER OF EACH.

Voluntary Self-Identification (CONFIDENTIAL – For Statistical Use Only)

We are an Equal Opportunity Employer and do not discriminate on the basis of race, color, religion, age, national origin, disability, veteran status, sexual orientation or any other classification protected by Federal, state, or local law. Completion of this data is voluntary and will not affect your opportunity for employment, or terms or conditions of employment, if hired. Identification can be declared at any time prior to, or if applicable, after hire.

ETHNIC GROUP : Please check one of the descriptions below corresponding to the ethnic group with which you most identify.

ETHNIC GROUP*

American Indian or Alaskan Native - A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian - (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American - (Not Hispanic or Latino) – A person having origins in any of the Black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black or African American.”
HISPANIC OR LATINO - A person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER - (Not Hispanic or Latino) – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
TWO OR MORE RACES - Not Hispanic or Latino
WHITE - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Gender

Male
Female

Personal and Confidential

This page contains sensitive information, which is stored in secure location, separately from personnel records.

NORTH FLORIDA SALES

Application for Employment

Records

Experience

Voluntary Self-Identification (CONFIDENTIAL – For Statistical Use Only)

Personal and Confidential