Daniel & Company, Inc.

A COMPLETED EMPLOYMENT APPLICATION IS REQUIRED FOR CONSIDERATION FOR ANY OPEN POSITION. EQUAL ACCESS TO PROGRAMS, SERVICES AND EMPLOYMENT IS AVAILABLE TO ALL PERSONS. THOSE APPLICANTS REQUIRING REASONABLE ACCOMMODATION TO THEIR APPLICATION AND/OR INTERVIEW PROCESS SHOULD NOTIFY THE OFFICE MANAGER OR HIRING MANAGER.

DANIEL & COMPANY, INC. IS AN EQUAL OPPORTUNITY EMPLOYER

Today's Date*

Enter Date in month/day/year format (Example: 08/10/2019)

Position Applied For*

PERSONAL

First Name*

Middle Name*

Last Name*

Preferred Name*

Street Address*

City*

State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming

Zip Code*

Phone Number*

Personal Email*

Are you a U.S. Citizen*

•    YES
•    NO

Are you legally eligible to work in the United States?*

•    YES
•    NO

Registration Number (if applicable)

If you answered "No" to U.S. Citizen, and "Yes" to being legally eligible to work in the U.S. you MUST provide your Registration Number, or your application will not be considered.

EDUCATION

High school graduate or equivalent?*

•    YES
•    NO

Date Diploma or GED Received*

Enter Date in month/year format (Example: 05/2019)

High School*

College or University
College City/State

Type of Degree Received
Date

Enter Date in month/year format (Example: 05/2019)

Subject or Specialization

College or University
College City/State

Type of Degree Received
Date

Enter Date in month/year format (Example: 05/2019)

Subject or Specialization

Languages (other than English) you can speak or write.

EMPLOYMENT HISTORY

LIST PAST EMPLOYMENT RECORD AS COMPLETELY AS POSSIBLE, STARTING WITH YOUR PRESENT OR MOST RECENT EMPLOYER. INCLUDE SELF-EMPLOYMENT and SUMMER EMPLOYMENT.

Resume Attached?*

•    YES
•    NO

Resume

EMPLOYER'S CONTACT INFO

DATES

JOB TITLE/TYPE OF WORK

REASON FOR LEAVING

Present or Last Employer*
Employer Address*
Employer Phone

Start*

Enter dates in month/year format (Example: 05/2019)

End*

Job Title and Type of Work*

Reason for Leaving*

Previous Employer
Employer Address
Employer Phone

Start

Enter dates in month/year format (Example: 05/2019)

End

Job Title and Type of Work

Reason for Leaving

Previous Employer
Employer Address
Employer Phone

Start

Enter dates in month/year format (Example: 05/2019)

End

Job Title and Type of Work

Reason for Leaving

Previous Employer
Employer Address
Employer Phone

Start

Enter dates in month/year format (Example: 05/2019)

End

Job Title and Type of Work

Reason for Leaving

INTEREST

Describe any Geographical/Travel Restrictions*

If none, type "none" in the field above.

Approximate Earnings Expected (hourly or salary)*

Enter number. No need to put any text. Your answer to the next field will tell us whether that number is per hour or per year.

Hourly or Salary*

•    Hourly
•    Salary

Can you work any day of the week?*

•    YES
•    NO

If no, when can't you work?

MILITARY

List Branch of Service

Date Entered

Enter Date in month/year format (Example: 05/2019)

Date Separated

Enter Date in month/year format (Example: 05/2019)

Rank when Separated

Do you have U.S. Armed Forces or National Guard Obligation

•    YES
•    NO

If Yes, Describe Obligation

SKILLS

ENTER MACHINERY OR EQUIPMENT YOU HAVE MORE THAN 1 YEAR OF EXPERIENCE USING, AND INDICATE THE NUMBER OF YEARS.

Machine Equipment

Number of Years

Machine/Equipment

Number of Years

Machine/Equipment

Number of Years

List any Special Skills or Certifications

List Professional Membership, Offices Held, or Special Awards Received

CURRENT EMPLOYMENT

Are you Currently Employed*

•    YES
•    NO

May We Contact Your Current Employer?*

•    YES
•    NO

If Hired, are You Willing to Transfer or Relocate?*

•    YES
•    NO

Were You Referred?*

•    YES
•    NO

If "Yes" indicate the relationship, and name of the person who referred you in the next fields.

How did you hear about this position?* Other Friend Relative Daniel & Company Website Daniel & Company Social Media Post Job Search Website Newspaper or Magazine Classified Ad
Please provide specifics on how you heard about this position.*

Relative Employed by Daniel & Company

Positions Held/Job Title

Relationship to You

Relative Employed by Daniel & Company

Positions Held/Job Title

Relationship to You

Relative Employed by Daniel & Company

Positions Held/Job Title

Relationship to You

Have you ever been employed by Daniel & Company?*

•    YES
•    NO

Date Started (month/year)
Date Separated (month/year)

Enter Date in month/year format (Example: 05/2019)

Reason for Leaving Daniel & Company

 

GENERAL

Have you ever been convicted of a felony or misdemeanor drug offense?*

•    YES
•    NO

If yes, explain

Have you ever been convicted of any other felony or misdemeanor?*

•    YES
•    NO

If yes, explain

Answering “yes” to either of the above listed questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.

Do you currently have a valid driver's license, and are you able to drive without restrictions?*

•    YES
•    NO

DANIEL & COMPANY, INC. IS AN EQUAL OPPORTUNITY EMPLOYER

APPLICANT STATEMENT

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application. I understand that that DANIEL & COMPANY does not lawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicants from consideration for employment on any basis prohibited by local, state or federal law.

I understand that any information provided that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) eliminate me from further consideration for employment, or (2) may result in discharge from service whenever it is discovered.

Signature (Print Full, Legal Name)*

Date*

I have read, understood, and agree with the Applicant Statement.*

•   YES