Claypool Distributing Company

102 CLAYPOOL DRIVE, IMPERIAL, CA 92251

760-355-1166 760-355-0975 FAX

EMPLOYMENT APPLICATION

(This application valid for 90 days)

(1) Name_____________________________________________ SS#

(2) Address___________________________________________ Ph#

City_______________________________________ State, Zip_____________________

CDL#_________________ State__________ E-Mail

(3) If under 18, date of birth____________ Name of parent or legal guardian:

(4) "I AM APPLYING ONLY FOR THE FOLLOWING JOB CLASSIFICATION(S)":

Date you can start____________ Have you worked here before? Y( N( Are you currently employed? Y( N(

May we contact your employer? Y( N( Are you available to work: Full-time ( Part-time ( Temporary(

(5) EDUCATION: Highest grade completed______ Degree

(6) NOTE ANY SPECIAL SKILLS, LICENSES OR TRAINING:

(7)EMPLOYMENT HISTORY: Last job first.—Not listing an employer, can result in immediate dismissal during interview &/or job termination.

Employer__________________________________________ Phone #_______________

Address___________________________________ City, State, Zip__________________

Position held_________________________ Supervisor(s)__________________________

Responsibilities___________________________________________________________

Dates Employed___________________ Reason for leaving________________________

Employer__________________________________________ Phone #_______________

Address___________________________________ City, State, Zip__________________

Position held_________________________ Supervisor(s)__________________________

Responsibilities___________________________________________________________

Dates Employed___________________ Reason for leaving________________________

Employer__________________________________________ Phone #_______________

Address___________________________________ City, State, Zip__________________

Position held_________________________ Supervisor(s)__________________________

Responsibilities___________________________________________________________

Dates Employed___________________ Reason for leaving________________________

Employer__________________________________________ Phone #_______________

Address___________________________________ City, State, Zip__________________

Position held_________________________ Supervisor(s)__________________________

Responsibilities___________________________________________________________

Dates Employed___________________ Reason for leaving________________________

Employer__________________________________________ Phone #_______________

Address___________________________________ City, State, Zip__________________

Position held_________________________ Supervisor(s)__________________________

Responsibilities___________________________________________________________

Dates Employed___________________ Reason for leaving________________________

(8) "If hired, I understand that I will be required to submit proof of identity and proof of my legal right to work in the United States. I understand that any falsifications or misstatements on this application can result in denial of or immediate dismissal from employment."

(9) "I hereby understand and acknowledge that employment is at the mutual consent of the employee and the employer. Accordingly, either the employee or the employer can terminate the employment relationship at will. It is further understood that this AT WILL employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this company."

(10) "I agree to a pre-placement physical examination and/or drug test at Co. expense."

Note: In order for this application to be reviewed by personnel, it MUST be accompanied by a current DMV license report. NO EXCEPTIONS.

APPLICANTS SIGNATURE____________________________________________DATE__________

Pavlo, Weinberg & Associates

Ray Eatwell

2018-02-02

Karla

EATWELL CONSULTING