Dixie HomeCrafters Job Application
Last Name
First Name, Middle Initial
Mailing Address
Last 4 digits of your SSN
XXX - XX -
City
State
Zip
Phone
Referral Source
Salary Desired
Email Address

Check the type of position you are seeking:

Sales
Marketing
Administrative
Production
Installer
Telemarketing
Canvassing
Other


Check box for yes, leave blank for no.

Are you 18 years of age or older?
Are you legally eligible to work in this country?
Are you subject to any "non-compete" agreements?
Have you been employed by us before?
If yes; when and where was your former position?

Are you related to anyone currently employed by this company? If so, who?

If driving is an essential requirement of the position, list your valid driver's license number:
State: Expiration Date:


Check box for yes, leave blank for no.

Have you ever been convicted of a crime?
If yes; please explain and provide dates

Employment History

Last Employer Name, Address, Phone
Supervisor Name, Title
Employed from
to
Reason for Leaving
Job Title & Salary
Describe your duties
Last Employer Name, Address, Phone
Supervisor Name, Title
Employed from
to
Reason for Leaving
Job Title & Salary
Describe your duties
Last Employer Name, Address, Phone
Supervisor Name, Title
Employed from
to
Reason for Leaving
Job Title & Salary
Describe your duties

Work References

Name & Location Title Phone Relationship

Education

Institution Name and Location of School Course of Study No. of Years Completed Did you Graduate? Degree
High School
College
Graduate School
Business/
Trade/
Technical

Other Qualifications

Other knowledge, skills, and abilities that you believe qualify you for the position you are seeking. Include licenses, certificates, formal training and/or other recognition. Do not disclose information that would reveal race, color, religion, age, disability, national origin, marital, or uniformed services status.

Applicant's Statement

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery. I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Dixie HomeCrafters Inc./GutterGuard LLC (the "Company") that such employment with the Company is "at will", for no specified duration and may be terminated by either the Company or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of the Company or its representatives used during the employment selection process is deemed a contract of employment, real or implied. I understand that no representative of the Company except the Chief Executive Officer has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the Chief Executive Officer.

In consideration for employment with the Company, if employed: (), I agree to conform to the rules, regulations, policies and procedures of the Company at all times and understand that such obedience is a condition of employment; (2), I understand that execution of an Alternative Dispute Resolution Agreement is a condition of employment; (3), I understand that due to the nature of the Company's business, attendance and punctuality are considered essential requirements of every job at the Company and that poor attendance or tardiness will result in disciplinary action; and (4), I understand that if offered a position with the Company, I will be required to submit to a criminal and driving record background check as a condition of employment, and I understand that if the Company concludes, in its sole discretion, that the outcome of the background check indicates that I am an unacceptable risk, the Company will withdraw any employment offer or terminate my employment if I am already employed.

I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to the Company and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information. I understand that this application is considered current for three months. If I wish to be considered for employment after this period I must complete and submit a new application.

DIXIE HOMECRAFTERS INC./GUTTERGUARD LLC IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, UNIFORMED SERVICES STATUS OR ANY OTHER STATUS PROTECTED BY LAW.

BY CHECKING THE BOX AND TYPING MY NAME BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.


Applicant Electronic Signature:

Date