Neiman Enterprises Devils Tower Forest Products Rushmore Forest Products Mountain West Millworks Box 218 Hulett WY 82720 Telephone 307.467.5252 APPLICATION FOR EMPLOYMENT: An Equal Opportunity Employer - This form is NOT to be filled out on-line and e-mailed. It is intended for your use by printing the form.Please complete by typing or printing requested information. Please hand-deliver the application to the place of business in which you are applying. If you are unable to deliver the application in person, please put a cover letter with your application and fax the completed form to Neiman Enterprises C/O Personnel at 307.467.5418. (Physical addresses where openings for employment are available will be listed on the page where openings are posted.) We do not discriminate on the basis of race, color, religion, national origin, sex, age, or disability. It is our intention that all qualified applicants be given equal opportunity and that selection decision be based on job-related factors. Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on final page of application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information. Job Applied For: ______________________________ Today's Date: _________________________________ Are you seeking: _____ Full-time _____ Part-Time ______ Temporary employment? If hired, when could you begin working? __________________ ________________ ________________ _______________ Last Name First Name Middle Name Telephone Number: ________________________________ Present Address: ____________________________________ (If P.O. Box list physical address too) City, State and Zip Code: _____________________________________________ Are you 18 years of age or older?........................... Yes O No O (If you are hired you may be required to submit proof of age.) Social Security Number ________________________ If hired, can you furnish proof you are eligible to work in the U.S.? Yes O No O Have you ever applied here before? Yes O No O If yes, when? ________________________________ Were you ever employed here? Yes O No O If yes, when? _______________________________ Have you ever been convicted of any law violation (except minor traffic violation)? Yes O No O If yes, give details: ________________________________________________ (A "Yes" answer does not automatically disqualify you from employment, since the nature of the offense, date, and the job for which you are applying will also be considered.) Are you now or do you expect to be engaged in any other business or employment? Yes O No O If yes, please explain:_______________________________________________ For Driving Jobs ONLY: Do you have a valid driver's license? Yes O No O Have you had your drivers license suspended or revoked in the last 3 years? Yes O No O If yes, give details: _______________________________________________ List professional, trade, business of civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.) _______________________________________________________________________ _______________________________________________________________________ EDUCATION High School: Name and Address of school:___________________________ or GED:___________________ No. Yrs.Completed _______ Diploma /Degree ____________ College or University: Name and Address of school:_____________________ ______________________ No. Yrs.Completed/Diploma Degree/Subjects Studied _______________________________________________________________________ Vocational or Technical: Name and Address of school:___________________ ________________________ No. Yrs.Completed/Diploma Degree/Subjects Studied _______________________________________________________________________ Skills or additional training: Do you have skills or additional training that are related to the job for which you are applying? Explain. _______________________________________________________________________ _______________________________________________________________________ Machines or equipment: What machines or equipment can you operate that are related to the job for which you are applying? Explain. _________________________________________________________________________ _____________________________________________________________________ Employment History: List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. PLEASE GIVE MONTH AND YEAR in dates of employment. NAME OF EMPLOYER: _________________________________ ADDRESS: ______________________________________________________________ CITY, STATE & ZIP CODE:________________________________________________ SUPERVISOR:_______________________ TELEPHONE NUMBER: __________________ Job Title and Duties:____________________________________________ Dates of Employment: FROM_____________ TO________________ Pay History: START______________ FINAL_________________ Reason For Leaving: __________________________________________________ NAME OF EMPLOYER: _________________________________ ADDRESS: ______________________________________________________________ CITY, STATE & ZIP CODE:________________________________________________ SUPERVISOR:_______________________ TELEPHONE NUMBER: __________________ Job Title and Duties:____________________________________________ Dates of Employment: FROM_____________ TO________________ Pay History: START______________ FINAL_________________ Reason For Leaving: __________________________________________________ NAME OF EMPLOYER: _________________________________ ADDRESS: ______________________________________________________________ CITY, STATE & ZIP CODE:________________________________________________ SUPERVISOR:_______________________ TELEPHONE NUMBER: __________________ Job Title and Duties:____________________________________________ Dates of Employment: FROM_____________ TO________________ Pay History: START______________ FINAL_________________ Reason For Leaving: __________________________________________________ NAME OF EMPLOYER: _________________________________ ADDRESS: ______________________________________________________________ CITY, STATE & ZIP CODE:________________________________________________ SUPERVISOR:_______________________ TELEPHONE NUMBER: __________________ Job Title and Duties:____________________________________________ Dates of Employment: FROM_____________ TO________________ Pay History: START______________ FINAL_________________ Reason For Leaving: __________________________________________________ NAME OF EMPLOYER: _________________________________ ADDRESS: ______________________________________________________________ CITY, STATE & ZIP CODE:________________________________________________ SUPERVISOR:_______________________ TELEPHONE NUMBER: __________________ Job Title and Duties:____________________________________________ Dates of Employment: FROM_____________ TO________________ Pay History: START______________ FINAL_________________ Reason For Leaving: __________________________________________________ NAME OF EMPLOYER: _________________________________ ADDRESS: ______________________________________________________________ CITY, STATE & ZIP CODE:________________________________________________ SUPERVISOR:_______________________ TELEPHONE NUMBER: __________________ Job Title and Duties:____________________________________________ Dates of Employment: FROM_____________ TO________________ Pay History: START______________ FINAL_________________ Reason For Leaving: __________________________________________________ Have you worked or attended school under any other name? Yes O No O If yes, give name(s):__________________________________________________ Are you presently employed? Yes O No O If yes, may we contact your present employer? Phone No. _______________ Have you ever been fired from a job or asked to resign? Yes O No O If yes, please explain: _____________________________________________ Give three references, not relatives or former employers and telephone numbers where they can be reached during normal working weekday hours. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 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 mission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. - I understand that the employer may request an investigative consumer report for a consumer-reporting agency. This report may include information as to my character, reputation, personal characteristics and mode of living obtained from interviews with neighbors, friends, former employers, schools and others. - I understand I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer-reporting agency in order that I may obtain a complete disclosure of the nature and scope of the investigation. - I authorize the investigation of any or all statements contained in this application and also authorize any personal, school, current employer, (except as previously noted), past employers, and organizations named in this application to provide relevant information and opinions that may be useful in making a hiring decision. - I release such persons and organizations from any legal liability in making such statements. - I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre and/or post employment drug screen as a condition of 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. - If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice. - I have read, understand, and by my signing consent to these statements. SIGNATURE:_____________________________ Date:_________________________________ THIS APPLICATION WILL REMAIN ACTIVE FOR A LIMITED TIME. ASK THE ORGANIZATION REPRESENTATIVE FOR DETAILS. ALL POSTIONS LISTED ARE AVAILABLE UNTIL FILLED.