Sunlight Supply Interactive Employment Application

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PERSONAL INFORMATION

Position Applying For: Salary Desired:

Name (Last) (First) (Middle) Are you employed now?

Address Home Telephone

City, State, Zip Code Alternate Telephone (please list cell or friend)

Name of relative working for Sunlight Supply Relationship

Have you ever

worked for

Sunlight Supply?

Where? When? Supervisor

Valid Current Driver’s License? o Yes o No CDL License? o Yes o No

License No: ____________________________ State: ______________ Class:______________

Has your Driver’s License ever been suspended or revoked? o Yes o No

If yes please explain:__________________________________________________________________________

Have you ever been convicted, pled no contest, had adjudication withheld, or had prosecution deferred on any

misdemeanor, felony, or DUI, or do you have any of these charges pending against you or are you currently

enrolled in a pre-trial intervention program? o Yes o No

If yes, please explain fully:_____________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Note: a conviction does not necessarily prevent your application from consideration. The nature, year of your

conviction, number of convictions, and the job for which you are applying are all taken into consideration.

Regardless of how you answer this question, all background checks will be performed.

APPLICATION FOR EMPLOYMENT

Page 1

Corporate Offices

5408 NE 88th St. Bldg. A,

Vancouver, WA 98665

Fruit Valley

4525 NW Fruit Valley Rd.

Vancouver, WA 98660

Woodland

1560 Downriver Drive

Woodland, WA 98674

Samoa

1900 Bendixsen St., Bldg 1

Samoa, CA 95564

Livermore

6485 Brisa Street

Livermore, CA 94550

Ontario

1051 S. Rockefeller Ave.,

CA Commerce Center #2,

Ontario, CA 91761

Denver

3550 B Odessa Way

Aurora, CO 80011

Detroit

30811 Century Drive

Wixom, MI 48393

York

450 Grim Lane

York, PA 17406

Nashville

126 Belinda Parkway

Mt. Juliet, TN 37122

Pompano

455 S. Andrews Ave.

Pompano Beach, FL 33069

OFFICE USE ONLY Interviewed o Yes o No Date Interviewed _____________

SLS Interactive Employment Application - Last Updated 05072015

EDUCATION AND SPECIAL TRAINING

Circle highest school grade completed: 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2

High school diploma or GED: o Yes o No

Name and address (city and state) of last high school attended: _________________________________________

_____________________________________________________________________________________________

LIST SPECIAL TRAINING (BUSINESS, TRADE, VOCATIONAL, ARMED FORCES SCHOOLS, ETC.) BELOW:

Name and location of vocation-

al school training center, insti-

tute, etc.

Dates Attended Total

Months

Completed

Courses or subjects

taken.

Certicates given

or other pertinent

information

From To

Mo. Yr Mo. Yr

LIST COLLEGES AND UNIVERSITIES ATTENDED BELOW:

Name and location of college or

university.

Dates Attended Total

Months

Completed

Grade

Point

Average

Major/minor eld or

program of study

Type of

degree

awarded

From To

Mo. Yr Mo. Yr

EMPLOYMENT RECORD

List the past 4 previous employers. Major changes in duties or job titles with the same employer should be list-

ed as separate jobs. Start with the present or most recent and work back. Use blank sheets if necessary. LEAVE

NO GAPS AND BE SPECIFIC IN YOUR ANSWERS.

Have you ever been terminated or asked to resign from any job?

If yes, please explain: _______________________________________________________________________

___________________________________________________________________________________________

_______________________________________________________________________________________

Present or Most Recent Job. Employer: ____________________________________________________

Address, City, State: __________________________________________________________________________

Telephone: ______________________ Supervisor: ________________________________________________

From: (month/yr) ______________ To: (month/yr) _______________ Job Title: ______________________

Hours per Week: ______ Starting Salary $ ________ Per ________ Last Salary $ ________ Per ________

Reason for Leaving: _________________________________________________________________________

Duties: ____________________________________________________________________________________

__________________________________________________________________________________________

May we contact this employer for a work reference? o Yes o No If no, please explain:________________

_________________________________________________________________________________________

Page 2

SLS Interactive Employment Application - Last Updated 05072015

Page 3

EMPLOYMENT RECORD continued:

Present or Most Recent Job. Employer: ____________________________________________________

Address, City, State: __________________________________________________________________________

Telephone: ______________________ Supervisor: ________________________________________________

From: (month/yr) ______________ To: (month/yr) _______________ Job Title: ______________________

Hours per Week: ______ Starting Salary $ ________ Per ________ Last Salary $ ________ Per ________

Reason for Leaving: _________________________________________________________________________

Duties: ____________________________________________________________________________________

__________________________________________________________________________________________

May we contact this employer for a work reference? o Yes o No If no, please explain:________________

_________________________________________________________________________________________

Present or Most Recent Job. Employer: ____________________________________________________

Address, City, State: __________________________________________________________________________

Telephone: ______________________ Supervisor: ________________________________________________

From: (month/yr) ______________ To: (month/yr) _______________ Job Title: ______________________

Hours per Week: ______ Starting Salary $ ________ Per ________ Last Salary $ ________ Per ________

Reason for Leaving: _________________________________________________________________________

Duties: ____________________________________________________________________________________

__________________________________________________________________________________________

May we contact this employer for a work reference? o Yes o No If no, please explain:________________

_________________________________________________________________________________________

Present or Most Recent Job. Employer: ____________________________________________________

Address, City, State: __________________________________________________________________________

Telephone: ______________________ Supervisor: ________________________________________________

From: (month/yr) ______________ To: (month/yr) _______________ Job Title: ______________________

Hours per Week: ______ Starting Salary $ ________ Per ________ Last Salary $ ________ Per ________

Reason for Leaving: _________________________________________________________________________

Duties: ____________________________________________________________________________________

__________________________________________________________________________________________

May we contact this employer for a work reference? o Yes o No If no, please explain:________________

_________________________________________________________________________________________

SLS Interactive Employment Application - Last Updated 05072015

REFERENCES

List below the names of three persons not related to you, whom you have known at least one year.

Name Address Telephone Years

Known

DO NOT WRITE BELOW THIS LINE

REMARKS

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

AUTHORIZATION

“I certify that the facts contained in this application are true and complete to the best of my knowledge and

understand that, if employed, falsied statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed and all

information concerning my previous employment and release the company from all liability for any damage that

may result from utilization of such information.

I understand that all information on this application is subject to verication and I consent to criminal history

background checks upon hire and at will thereafter while employed.

This waiver does not permit the release or use of disability-related or medical information in a manner

prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

I understand as a condition of employment I will be required to sign a non-compete and condentiality

agreement.

Date _______________________ Signature _______________________________________________________

Interviewed by_____________________________________________________ Date _______________________

Location Supervisor

Start

Date

For

Dept Position

Salary

Wages

Page 4

SLS Interactive Employment Application - Last Updated 05072015

STOP - See Note Below

Checking this box will serve as your electronic signature and your agreement to the statement above. If you are hired,

we will obtain your physical signature on this application during your new hire orientation.

Date: