Employment ApplicationMiami Industrial Supply is proud to offer a 401K program, health benefits and paid vactions.Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstMiddleLastSSN *Day PhoneNight PhoneEmail *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact NameEmergency Contact Telephone NumberHave you ever worked for Miami Industrial Supply before? *YesNoIf so, dates: From - ToPositionDepartmentWere you referred by a Miami Industrial Supply or affiliated company employee? *YesNoIf so, whom?For what position are you applying?Desired starting Pay: $_______ per _______ *How many hours per week do you want to work? *During what times of the week are you available to work? *Are you willing to work nights? *YesNoAre you willing to work weekends? *YesNoAre you willing to work holidays? *YesNo would Explain of Do you have reliable transportation? *YesNoIf not, explainDo you have a Drivers License *YesNoAny endorsements on drivers license?Do you have reliable transportation? *YesNoIf not, explainDo you have a Drivers License *YesNoWhen could you begin work? *Are you at least 16 years old? *YesNoAre you at least 18 years old? *YesNoSkills and ExperienceList any special qualifications, training, education, skills, or experience that you believe warrant consideration by the company:EducationHighest elementary or high school grade completed:Did you graduate from high school? *YesNoG.E.D.Name/location of college, university, business or trade school:12Dates attendedFrom:__________To:__________From: __________To:__________Full Time or Part TimeFull Time:__________ Part Time:__________Full Time:__________ Part Time: __________ Major field of studyTitleTitleDegrees conferredTitle: __________ Date:__________Title: __________ Date:__________Hours creditTotal hoursTotal hoursWork ExperienceJob 1Name of present or Last EmployerPhoneStreet AddressCity and StateStarting Date (MM/YY)Leaving Date (MM/YY)Starting SalaryEnding SalaryJob TitleName of SupervisorFull time or Part timeType of BusinessJob Description and Responsibilities:Were you fired? *YesNoExplain reason/circumstances for changing or wanting to change jobs.If we contact this employer, would you expect them to say they would rehire you for the position you last held there? *YesNoExlpainJob 2Name of Next Previous EmployerPhoneStreet Address City and StateStarting Date (MM/YY) Leaving Date (MM/YY) Starting Salary Ending Salary Job Title Name of Supervisor Full time of Part time Type of Business Job Description and Responsibilities: Were you fired? *YesNoExplain reason/circumstances for changing or wanting to change jobs.If we contact this employer, would you expect them to say they would rehire you for the position you last held there? *YesNoExplainJob 3Name of Next Previous Employer Phone Street Address City and State Starting Date (MM/YY) Leaving Date (MM/YY) Starting Salary Ending Salary Job Title Name of Supervisor Full time of Part time Type of BusinessJob Description and Responsibilities: Were you fired? *YesNoExplain reason/circumstances for changing or wanting to change jobs. (copy)If we contact this employer, would you expect them to say they would rehire you for the position you last held there? (copy) *YesNoExplainReferencesReference 1 - Name:Title:CompanyPhoneReference 2 - Name: Title: Company PhoneReference 3 - Name: Title: Company Phone LegalHave you ever been convicted of a crime other than a traffic violation? *YesNoIf yes, date of conviction:Please explain:MessageSignatureBy signing this application for employment, I certify that I have read and understand all parts of it and certify that I have truthfully and completely answered all questions. I understand that falsification of any of the information given herein or on any other employment form is grounds for immediate termination, regardless of when such falsification may be discovered.I authorize Miami Industrial Supply and its affiliates to investigate my education and employment experience and all other aspects of my background relevant to my proposed employment, including all statements made by me in my application for employment. I understand Miami Industrial Supply or affiliated companies may contact the appropriate credit bureau to obtain an investigative consumer report providing information about my character. I understand I may request (in writing from the Personnel Department) a complete and accurate disclosure of information concerning the nature and scope of this report. I also release Miami Industrial Supply and their affiliates, as well as any person to whom such inquiry is directed, from any liability arising directly or indirectly from any such investigations. Further, I understand that employment be contingent upon successfully passing a post-offer, pre-employment drug screening test.I understand my employment with Miami Industrial Supply or its affiliates, is for no definite length of time. I understand my employment may be terminated at any time, with or without cause, with or without notice, at the option of either Miami Industrial Supply or its affiliates, or myself. I understand that no employee or representative of Miami Industrial Supply or its affiliates has any authority to make any agreement which is contrary to the foregoing.If accepted for employment, I agree to comply with all company policies and procedures, and with all rules and regulations made known at the time of employment or any other time thereafter; and to perform all duties assigned to me to the best of my ability.Signature * Clear SignatureDate / Time *DateTimeMiami Industrial Supply is an equal opportunity employer. All applications for employment will be considered without regard to race, color, religion, sex, national origin, disability, or age (over the age of 40).This application will remain active for 60 days. After that time, it must be renewed by the applicant if he/she wishes to be reconsidered for employment.Thank you for applying. Submit
