Application for Employment

EMPLOYMENT APPLICATION - Please complete the entire application.

Employer Information Employer: Quality Glass of Athens
Address: 234 Old Epps Bridge Road
City/State/ZIP: Athens, Georgia 30606
Telephone: 706-548-4481

It is the policy of Quality Glass of Athens to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability, or veteran status.

Applicant Information

Applicant Full Name: ___________________________________________

Home Address: ___________________________________________

City/State/ZIP: ___________________________________________

Number of years at this address: _________

Daytime phone:____________________Evening phone: ____________________

Mobile phone: ____________________

Social Security Number: ___________________________

Driver's License (State/Number): ___________________________

Emergency Contact

Who should be contacted if you are involved in an emergency?

Contact Name: ___________________________________________

Relationship to you: ___________________________________________

Address: ___________________________________________

City/State/ZIP: ___________________________________________

Daytime phone:____________________Evening phone: ____________________

.Job Position Applied For:

____________________________________

Full or Part Time? ____________________________________

Salary Desired: $ ____________ per ____________

Who referred you to our company? ______________________________________

Do you have any friends or relatives who work here? If yes, please list here:

__________________________________________________________

Have you applied to our company previously? ______ Yes ______ No

If yes, when? ________________________

Are you at least 18 years old? ______ Yes ______ No

How will you get to work? _____________________________________

Are you willing to work any shift, including nights and weekends? _____ Yes _____ No

If no, please state any limitations:

________________________________________________

If applicable, are you available to work overtime? _____ Yes _____ No

If you are offered employment, when would you be available to begin work?

____________________________________

If hired, are you able to submit proof that you are legally eligible for

employment in the United States? _____ Yes _____ No

Applicant's Skills

List any skills that may be useful for the job you are seeking. Enter the number of years of experience and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Ability or Skill Years of Experience Rating

______________________________________________ 1 2 3 4 5

Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

Employer Name: ___________________________________________

Supervisor Name: ___________________________________________

Address: ___________________________________________

City/State/ZIP: ___________________________________________

Job Duties: ___________________________________________

Reason for Leaving: ___________________________________________

Dates of Employment (Month/Year): _____________________________

Additional History

Employer Name: ___________________________________________

Supervisor Name: ___________________________________________

Address: ___________________________________________

City/State/ZIP: ___________________________________________

Job Duties: ___________________________________________

Reason for Leaving: ___________________________________________

Dates of Employment (Month/Year): _____________________________

Additional History

Employer Name: ___________________________________________

Supervisor Name: ___________________________________________

Address: ___________________________________________

City/State/ZIP: ___________________________________________

Job Duties: ___________________________________________

Reason for Leaving: ___________________________________________

Dates of Employment (Month/Year): _____________________________

Applicant's Education and Training

College/University Name and Address

____________________________________________________________

Did you receive a degree? ______ Yes _____ No If yes, degree(s) received: ___________

High School/GED Name and Address

____________________________________________________________

Did you receive a degree? ______ Yes _____ No

Other Training (graduate, technical, vocational):

____________________________________________________________

Please indicate any current professional licenses or certifications that you hold:

____________________________________________________________

Awards, Honors, Special Achievements:

____________________________________________________________

Military Service:

______ Yes _____ No

Branch: ___________________________________________

Specialized Training: ___________________________________________

References

List any two non-relatives who would be willing to provide a reference for you.

Name: ___________________________________

Address: ___________________________________

City/State/ZIP: ___________________________________

Telephone: _______________________

Relationship: _______________________

Name: ___________________________________

Address: ___________________________________

City/State/ZIP: ___________________________________

Telephone: _______________________

Relationship: _______________________

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

____________________________________________________________

CERTIFICATION

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Quality Glass of Athens to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Human Resources Manager, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Quality Glass of Athens, except in a specific written contract of employment signed on behalf of the organization by its Human Resources Manager, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

____________________________________ _______________

APPLICANT SIGNATURE DATE