Job Application - Carroll Distributing Company

First Name*
Middle Name
Last Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Email*
Only U.S. citizen or aliens who have a legal right to work in the U.S. are eligible for employment. Can you upon employment submit documentation verifying your legal right to work in the U.S and your identity?*
- Yes
- No
In order to permit a check of your work and educational records, should we be made aware of any change of name or assumed name that you previously used?*
- Yes
- No
If Yes, identify name and relevant dates.

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Skills and Qualifications
Summarize any training, skills, licenses and/or certifications, academic achievements and/or honors that may qualify you as being able to perform job-related functions in the position(s) for which you are applying
Are you a veteran of the U.S. Military Services?
- Yes
- No
If Yes, what branch of Service?
If Yes, give beginning date of active duty.
And ending date of active duty.

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Character References
List below three references whom you have known at least one (1) year, that are not related to you
First Reference
Name
Occupation
Years Known
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Second Reference
Name
Occupation
Years Known
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Third Reference
Name
Years Known
Occupation
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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Employment Experience
Starting with your most recent job, provide the information requested below for your current and past employers or periods of unemployment for the past 8 years. Please complete this section and indicate month and year for all employment dates.
Most Recent Job
Employer
Position
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed (Start and End Dates)
Hourly Rate or Salary (Starting and Ending)
Description of Work & Responsibilities
Reason for Leaving
May we contact this Employer?
- Yes
- No

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Employment Experience
Starting with your most recent job, provide the information requested below for your current and past employers or periods of unemployment for the past 8 years. Please complete this section and indicate month and year for all employment dates.
Next Most Recent Job (1)
Employer
Position
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed (Start and End Dates)
Hourly Rate or Salary (Starting and Ending)
Description of Work & Responsibilities
Reason for Leaving
May we contact this Employer?
- Yes
- No

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Employment Experience
Starting with your most recent job, provide the information requested below for your current and past employers or periods of unemployment for the past 8 years. Please complete this section and indicate month and year for all employment dates.
Next Most Recent Job (2)
Employer
Position
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed (Start and End Dates)
Hourly Rate or Salary (Starting and Ending)
Description of Work & Responsibilities
Reason for Leaving
May we contact this Employer?
- Yes
- No

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Employment Experience
Starting with your most recent job, provide the information requested below for your current and past employers or periods of unemployment for the past 8 years. Please complete this section and indicate month and year for all employment dates.
Next Most Recent Job (3)
Employer
Position
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dates Employed (Start and End Dates)
Hourly Rate or Salary (Starting and Ending)
Description of Work & Responsibilities
Reason for Leaving
May we contact this Employer?
- Yes
- No

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Background Questions
A conviction will not necessarily disqualify you from employment.
Have you ever been convicted of, had adjudication withheld, prosecution deferred, or fined and/or sentenced for any criminal offense (misdemeanor or felony)?
- Yes
- No
Do you currently have any criminal charges pending?
- Yes
- No
Did you ever plead guilty or “No Contest” to any criminal offense (misdemeanor or felony)?
- Yes
- No
Have you ever been into any type of pre-trail intervention program in connection with a crime involving dishonesty or a crime involving violence to another person?
- Yes
- No
If answered yes to any of these questions, give dates, place and nature of crime:
If you would like to submit a Resume please attach
Accepted file types: pdf, doc, docx, txt, xls, xlsx, csv, Max. file size: 50 MB.

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Employment Application