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Personal Information
Last Name:First Name:Middle Name:Preferred Name
Address:CityStateZip Code
Phone # with Area CodeE-Mail
Salary Desired
Are you over the age of 18:
Yes No

Employment History:

1.

May We contact your present employer? Yes No

Company Name:
Street:
City:State:
Phone:Date From:Date End:
Starting Salary:Final Salary:Full Time or Part Time:
Full Time Part Time
Position:Supervisors Name:
Description of Job Reponsibilities
Reason(s) for Leaving

2.

Company Name:
Street:
City:State:
Phone:Date From:Date End:
Starting Salary:Final Salary:Full Time or Part Time:
Full Time Part Time
Position:Supervisors Name:
Description of Job Reponsibilities
Reason(s) for Leaving

3.

Company Name:
Street:
City:State:
Phone:Date From:Date End:
Starting Salary:Final Salary:Full Time or Part Time:
Full Time Part Time
Position:Supervisors Name:
Description of Job Reponsibilities
Reason(s) for Leaving

4.

Company Name:
Street:
City:State:
Phone:Date From:Date End:
Starting Salary:Final Salary:Full Time or Part Time:
Full Time Part Time
Position:Supervisors Name:
Description of Job Reponsibilities
Reason(s) for Leaving

Personal History
Can you perform the essential functions of the position you have applied? Yes No
Have you ever been convicted of a felony? (A conviction record will not necessarily eliminate your candidacy for employment) Yes No
If you answered "yes" please describe fully the criminal conviction(s), listing the nature of the offense(s), and the date(s) of the offense(s) and conviction(s).
Are you able, at the time of employment, to submit verification of your legal right to work in the U.S.? Yes No

Skills or interests
Please list professional licenses and certificates.
Please list computer skills if applicable.
Please list any other pertinent skills or applicable interests.

References
Please list references we may contact.
NameOccupationPhone #

Disclaimer

Disclosure, Authorization and Consent for Pre-Employment Screening


     I certify that all information I have provided in order to apply for and secure employment with Doyle's Sheehan, is true and correct.

     In connection with my application for employment, I hereby authorize Doyle's Sheehan and any agent it authorizes to perform a pre-employment background screening check (including future screenings for retention, promotion, or re-assignment if applicable unless revoked in writing). I understand and agree to the following:

     I understand that Doyle's Sheehan may obtain a Consumer Report, which consists of information having a bearing on job performance and may include information from public and private sources, public records, courts, schools, former employers and references concerning my driving record, court records, credit history, education, credentials, identity and previous employment.

     I authorize and release people, companies, references, current and former employers, schools, credit bureaus, municipal, county, state and federal agencies and courts, to provide all information that is requested to the employer or its authorized agents. I further release and hold harmless all of the above, including the employer, to the full extent permitted by law, from any liability or claims arising from retrieving and reporting of information concerning me. I agree that a copy or fax of this document shall be as valid as the original. I certify that the following facts and the information in my resume and/or application are true and correct.

     I verify and affirm that all the information on this application form is true and correct. Any false information or material omission is grounds to terminate the hiring process, or to terminate employment if it has started.

     I understand that this application is being considered for the position that I applied for. If I am unsuccessful in gaining employment and still wish to be considered, it will be necessary to reapply for the position in which I am interested.

     I understand all newly hired employees are subject to a six month probationary period which may be extended at the sole discretion of Doyles Sheehan, Inc. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE AUTHORIZATION STATEMENTS.
Full Name:Date:
Copyright Doyle's Wholesale/Sheehan Majestic 2007