General Information

1. Date
2. First Name
3. Last Name
4. Social Security Number
5. Birthdate
6. Home Telephone:
7. Mobile Telephone:
8. Present Address Street Number Apt. Number City, State, Zip
9. How long have you lived at your present address?

Work Related

1. Position Applied For:
2. Which Southpoint Office: Duncan, South CarolinaPanacea, Florida
3. Salary Desired:
4. Days Available for Work:
5. How many weekly hours are you available for?
6. Will you work nights? Yes No
7. When are you available to start?

Education Information

1. High School
2. Name of School
3. School Location
4. Did you earn a High School Diploma? Yes No
5. College
6. Name of School
7. School Location
8. Number of Years Completed
9. Major & Degree
10. Business or Trade School
11. Name of School
12. School Location
13. Number of Years Completed
14. Major & Degree

Identification Information

1. Have you ever been convicted of a felony? Yes No
2. If so, specify:
3. Do you have a Driver’s License? Yes No
4. Driver's License Number:
5. License Type OperatorCommercial(CDL)Chauffeur
6. State:
7. Exp. Date:
8. What are your means of Transportation?
9. How many accidents have you had in three years?
10. How many moving violations have you had in three years?

Computer Related

1. Have you had any training in typing? Yes No
2. WPM (Words-Per-Minute):
3. Have you had any training on a computer? Yes No
4. PC Mac
5. Please list any other computer related skills you possess:

References

1. Two references other than relatives or previous employers
2. Name
3. Relationship to Applicant
4. Telephone Number
5. Address Street Number Apt. Number City, State, Zip
6. ______________________________________________________________
7. Name
8. Relationship to Applicant
9. Telephone Number
10. Address Street Number Apt. Number City, State, Zip
11. ______________________________________________________________
12. Work-related References, Current or last two jobs
13. Name of Employer
14. Telephone
15. Are you currently employed here? Yes No
16. Address Street Number Apt. Number City, State, Zip
17. Name of last supervisor
18. Employed From
19. Employed To
20. Pay or Salary
21. Your Last Job Title
22. Reason for Leaving (be specific)
23. Job Duties
24. ______________________________________________________________
25. Name of Employer
26. Telephone
27. Are you currently employed here? Yes No
28. Address Street Number Apt. Number City, State, Zip
29. Name of last supervisor
30. Employed From
31. Employed To
32. Pay or Salary
33. Your Last Job Title
34. Reason for Leaving (be specific)
35. Job Duties
36. May we contact your present employer? Yes No

Miscellaneous Information

1. Did you complete this application yourself? Yes No
2. If not, who did?
3. Have you ever been in the armed forces? Yes No
4. Are you now a member of the national guard? Yes No
5. Specialty
6. Date Entered
7. Discharge Date

Terms

1. "In exchange for the consideration of my job application by Southpoint Industries, Inc. (hereinafter called “the Company”), I agree that:
   
      Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Southpoint Industries, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both the undersigned and Southpoint Industries, Inc. may end the employment relationship at any time, without specified noticed or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
   
      I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers *unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.
   
      I also understand that (1) the Company has a drug and alcohol policy that provides from preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examination.
   
      I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requesting by it, as required by the Fair Credit Reporting Act.
   
      I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.
   
      This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex sexual orientation, national origin, citizenship, age, or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.
   
   By click "Submit" below, you agree to the above terms.