Employment Application

Asterisk (*) at the end of each question is required and must have an answer in it. If a question on the application does not apply to you, please type NA in the answer field.

First Name *

Middle Initial *

Last Name *

Your Email *

Phone Number*

Mobile Phone Number*

Current Address*

How long have you lived at this address?*

Previous Address*

City*

State *

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip *

How long did you live at this address?*

Position Sought*

Desired Pay Range*

Do you seek to work full-time or part-time?*

If part-time, please specify days and hours.*

Have you worked for us before?*

Yes No

If yes, where & when?

If hired, what date would you be available to start work?*

High School: Name & Location, Degree Received*

College/ University: Name & Location, Degree Received*

Specialized Training/ Trade School: Name & Location, Degree Received*

Other Education: Name & Location, Degree Received*

Additional skills, experiences, or qualifications which you feel apply to the position you are seeking.*

If hired, do you have a reliable means of transportation?*

Yes No

Do you have a valid driver’s license?*

Yes No

Have you ever been convicted of a crime, excluding misdemeanors and summary offenses?*

Yes No

If yes, please explain.*

Most Recent Employer: Company Name & Location*

Position & Dates Employed*

Previous Employer: Company Name & Location*

Position & Dates Employed*

Previous Employer: Company Name & Location*

Position & Dates Employed*

Reference 1: Name, Phone Number, Relationship to Applicant*

Reference 2: Name, Phone Number, Relationship to Applicant*

Reference 3: Name, Phone Number, Relationship to Applicant*

Resume: Copy and paste your resume here*

How did you hear about Henderson Glass?*

PLEASE READ CAREFULLY: APPLICANT’S CERTIFICATION AND AGREEMENT>>> I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice. AT-WILL EMPLOYMENT>>> If hired, I agree that the Corporation, at its sole discretion, may terminate my employment at its will for any reason or no reason, with or without cause, at any time, with or without advance notice or warning, and that its decision is not subject to outside review (except as may be provided by applicable statute). I understand and agree that no employee, manager, executive, board member or other representative of the Corporation, other that the president/ CEO, has any authority to enter into any agreement for employment for any specified period of time or to make any oral or written representation or practice contrary to the at-will nature of my employment. I further understand and agree that only an agreement in writing expressly for the purpose of modifying the at-will nature of my employment and signed by me and the president/ CEO of the Corporation can modify the at-will nature of my employment. I understand and agree that no other oral or written statement, policy or practice can change the at-will nature of my employment. I also understand and agree that by executing this application, I would be accepting employment, if hired, as an at-will employee and my acceptance of employment as an at-will employee would supersede, revoke, cancel, and negate any prior statement, agreements, practices, policies, and representations, oral or written, if any, that the Corporation would employ me on other than an at-will basis or for other than an indefinite term. I agree to abide by all rules and regulations of the Corporation. By entering my full name below, I acknowledge my understanding and agreement to the above.*

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