Application for Employment

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other legally protected
status. It is our intention that all qualified applicants be equal opportunity and that selection decisions be based on job-related
factors.

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Your Company Information

Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

Position Applied for:

Today’s Date:

Are you seeking:

Full-timePart-timeTemporary

When can you start work?

Desired Salary?

Last Name

First Name

Present Street Address

City/State

Zip Code

Present Mailing Address if different than above

E-mail address:

Phone Number:

Message Phone Number:

Are you 18 years of age or older?……………………………

YesNo

(If you are hired you may be required to submit proof of age.)

If hired, can you furnish proof you are eligible to work in the U.S.?

YesNo

If yes, give details:

List professional, trade, business, or civic activities and offices held (Exclude labor organizations and
memberships which reveal race, color, religion, national origin, sex, age, disability or other protected
status)

List name and address of schools:

Number of Years Completed

Diploma / Degree

Subjects Studied

High School or GED:

College or University:

Vocational or Technical:

What skills or additional training do you have that are related to the job for which you are applying?

What machines or equipment can you operate that are related to the job for which you are applying?

State any other additional information you feel may be helpful to us in considering your application.

Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job or occupation for which you have applied?

YesNo

References:

1. Name

Phone

Address

2. Name

Phone

Address

3. Name

Phone

Address

EMPLOYMENT EXPERIENCE-Must be completed.

Do not state “See Resume”

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status. Veteran’s Credit Applicable.

Employer

Phone

Job Title

Supervisor

Start Year

End Year

Address

Work Performed

Reason for leaving

Please read each statement carefully before signing.

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me form further consideration for employment and may result in my dismissal if discovered at a later date.

I authorize and agree to cooperate in a thorough investigation of all statements made herein and other matters relating to my background and qualifications. I understand that any investigation conducted may include a request for employment and educational history, credit reports, consumer reports, Investigative Consumer Reports, driving record and criminal history. I authorize any person, school, current and former employer, consumer reporting agency, and any other organization or agency to
provide information relevant to such investigation and I hereby release all persons and corporations requesting or supplying information pursuant to such investigation form all liability or responsibility to me for doing so. I understand that I have the right to make a written request within a reasonable period of time for complete disclosure of the nature and scope of any investigation. I further authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the job for which I am being considered or any future job in the event that I am hired.

I understand that I may be required to successfully pass a drug-screening. I hereby consent to pre- and/post-employment drug screen and physical examination (where applicable) as a condition of my employment, if required.

I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time.

I have read, understand, and by my signature consent to these statements.

Signature: Date:

This application for employment will remain active for 6 months
Unless otherwise specified by the HR Manager.

Family owned and operated since 1930

www.smardan.com

810 E. Mason Street
Santa Barbara, CA 93103
PH: 805-963-8991
Fax: 805-966-3586
14009 Halldale Avenue
Gardena, CA 90249
PH: 310-532-5260
Fax 310-532-2567
17273 Mt. Hermann St
Fountain Valley, CA 92708
PH: 714-545-6912
Fax: 714-545-3496
257 Tank Farm Road
San Luis Obispo, CA 93405
PH: 805-543-0664
Fax: 805-543-0810
262 W Alameda Avenue
Burbank, CA 91502
PH: 818-845-2477
Fax: 818-955-8248