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MERRILL DISTRIBUTING, INC Job Application

1301 N Memorial Drive Box 707      Phone    715-536-4551

Merrill WI 54452-0707                     Fax        715-536-5757

Personal Information

Last

First

MI

Email

Street Address

City

ST

Zip

Home Phone

Mobile

Are you entitled to work in the United States?

Are you 18 or older?

If yes, Date of Birth

Have you been convicted of a felony or been incarcerated in connection with a felony in the past seven years?

If yes, please explain:

What position are you applying for?  Full time or Part Time?

How did you hear about this position?

Expected Hourly Rate OR

Expected Yearly Earnings

Date Available

Prior Work Experience

Current or Most Recent

Prior

Prior

Employer

Address

City, ST, ZIP

Telephone

Name of Immediate Supervisor

Dates of Employment

From

To

From

To

From

To

Position/Job Title

Pay

Reason for Leaving

May We Contact

Education

Name/Location

Last Year Complete

Degree

Major

High School

9    10    11    12

College/University

1    2    3    4

Trade School

Other

List any applicable special skills, training or proficiencies.  Include Driver’s License number if applying for driving position.

 

MERRILL DISTRIBUTING, INC Job Application

1301 N Memorial Drive Box 707      Phone    715-536-4551

Merrill WI 54452-0707                     Fax        715-536-5757

References

     Name                                              Phone                     Years Known/Relationship

Other Comments

Disclaimer:  By signing, I hereby certify that the above information, to the best of my knowledge, is correct.  I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired.  I also provide consent for former employers to be contact regarding work records.

Signature:

Date: