Employment Application

Education
High School
Name*
Address*
City State
From / To*
Did you graduate?*
- Yes
- No
If so, when?*
University / Trade School
Name*
Address*
City State
From / To*
Did you graduate?*
- Yes
- No
If so, when?*

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Previous Employment
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Job Title*
Supervisor*
Responsibilities*
From / To*
Reason for leaving*
Ending Salary*
May we contact your supervisor?*
- Yes
- No
Additional Previous Employment
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Job Title*
Supervisor*
Responsibilities*
From / To*
Reason for leaving*
Ending Salary*
May we contact your supervisor?*
- Yes
- No
Additional Previous Employment
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Job Title*
Supervisor*
Responsibilities*
From / To*
Reason for leaving*
Ending Salary*
May we contact your supervisor?*
- Yes
- No

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Disclaimer and Signature
I CERTIFY that the information contained in the employment application I submit to Southern Components, Inc is true and complete to the best of my knowledge. I understand that material omissions or falsification of this application in any detail may result in my disqualification from consideration for employment or for dismissal from employment.

I AUTHORIZE Southern Components, Inc to conduct a background check and consumer reporting check, which includes information on my criminal history, credit history, and employment background, as part of a pre-employment screening, and if hired, during my time of employment. I release Southern Components, Inc. from any liability that this may cause if I am not hired due to this information.

I AGREE that Southern Components, Inc and any previous employers listed in this application and/or that are provided by me in writing or verbally will not be held liable in any respect if an employment offer is not made, is withdrawn, or my employment is terminated because of misrepresentations or omission of requested information.

I UNDERSTAND that upon offer of employment and acceptance that I will be required to furnish documents establishing my identity and eligibility to be legally employed in the United States. I understand that Southern Components, Inc participates in E-Verify which provides the federal government with your Form I-9 information to confirm that you are authorized to work in the United States.

I UNDERSTAND that employment with Southern Components, Inc is at-will. Employment at-will may be terminated at the will of either me or the Company. Employment may be terminated with or without cause at any time by me or by the Company. Terms and conditions of employment with the Company may be modified at the sole discretion of Southern Components, Inc with or without cause and with or without notice
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Date*
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Southern Components, Inc.

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Applicant Information

Education

High School

University / Trade School

Previous Employment

Additional Previous Employment

Additional Previous Employment

Disclaimer and Signature