Employment Application

AACER ACQUISITION, LLC d/b/a AACER FLOORING - AN EQUAL OPPORTUNITY EMPLOYER

PERSONAL INFORMATION

Name:

Are you under 18?  Yes No If yes, date of birth: //

Address:

Home Phone: Work Phone: Mobile Phone:

Email Address:

Emergency contact name and phone:

Are you either: (1) a U.S. citizen or, if not, (2) do you currently have lawful employment authorization which permits you to work for Aacer Acquisition, LLC d/b/a Aacer Flooring without Aacer Acquisition, LLC d/b/a Aacer Flooring having to take any action, either upon employment, or at any date in the future, to ensure or assist you in maintaining lawful employment authorization to work for Aacer Acquisition, LLC d/b/a Aacer Flooring?
 Yes No

If your answer was "No," answer the following question: Are you a student on a temporary visa?
 Yes No

Proof of authorization to work will be required your first day of employment if you are employed by Aacer Acquisition, LLC d/b/a Aacer Flooring.

Aacer Acquisition, LLC d/b/a Aacer Flooring is not currently hiring any individuals for whom Aacer Acquisition, LLC d/b/a Aacer Flooring would have any responsibility for applying for, or assisting in, any application for employment authorization which would permit lawful employment with us.

Have you ever worked at Aacer Acquisition, LLC d/b/a Aacer Flooring?  Yes No

If yes, when? From: // To: //

Name then (if different):

Reason for leaving:

GENERAL INFROMATION

Position(s) applied for:

Date available for work: //

Applying for:  Full Time Part Time Temporary

Desired Compensation: $

Are you professionally licensed or registered with any professional group, association or society relating to the job for which you are applying?  Yes No

If yes, name of group:

Registration or license number: State:

Date of expiration: //

If you are applying for a position which requires you to drive an automobile as part of your job, what is your driver's license number and state of issue?

Driver's License Number: State of Issue:

Can you perform the essential functions of the position for which you are applying with or without reasonable accommodation?
 Yes No

(If you have any questions as to the essential functions of a specific role; please ask the interviewer before you answer this question).

On occasion, we work more than 40 hours per week -- is that a problem?  Yes No

Aacer Acquisition, LLC d/b/a Aacer Flooring will attempt to reasonably accommodate an applicant's religious needs, as required by law.

What shift are you available?  First: 5:00am – 3:30pm M-TH Second: 3:15pm – 1:45am M-TH

Do you have transportation to work?  Yes No

Have you ever been denied a bond?  Yes No

If yes, explain:

SPECIFIC WORK SKILLS

All applicants - please list any additional experiences, skills and qualifications which you believe relate to the job or jobs for which you are applying:

PERSONAL COMPUTER SKILLS

All applicants – please list personal computers with which you are familiar:

Please list specific software programs with which you are familiar:

EDUCATION

High School:

Years completed:  1 2 3 4 Did you graduate:  Yes No

Business/Technical School:

Years completed:  1 2 3 4 Did you graduate:  Yes No

List diplomas, degrees and courses of study:

College:

Years completed:  1 2 3 4 Did you graduate:  Yes No

List diplomas, degrees and courses of study:

Please list any academic honors you have received which you believe relate to the job or jobs for which you are applying:

WORK HISTORY

PRESENT OR LAST EMPLOYER

Employed from / to /

Address:

Type of work:

Starting salary: $ Last salary: $

 Full Time Part time

Name/extension of supervisor

Reason for leaving:

If this is your current employer, may we contact for a reference?  Yes No

NEXT PREVIOUS EMPLOYEER

Employed from / to /

Address:

Type of work:

Starting salary: $ Last salary: $

 Full Time Part time

Name/extension of supervisor

Reason for leaving:

NEXT PREVIOUS EMPLOYEER

Employed from / to /

Address:

Type of work:

Starting salary: $ Last salary: $

 Full Time Part time

Name/extension of supervisor

Reason for leaving:

NEXT PREVIOUS EMPLOYEER

Employed from / to /

Address:

Type of work:

Starting salary: $ Last salary: $

 Full Time Part time

Name/extension of supervisor

Reason for leaving:

EMPLOYMENT AGREEMENTS: Are you subject to any employment agreement or post-employment agreement with any other employer (including, but not limited to, employment contracts, non-compete agreements, intellectual property rights agreements and/or confidentiality agreements)?

 Yes No

If yes, attach a complete and accurate copy of each agreement.

READ, UNDERSTAND, SIGN AND DATE IF YOU AGREE

I certify that the facts set forth in this application are true, correct and complete without misrepresentations or omissions of any kind whatsoever. I authorize investigation of the statements I have made herein.

I hereby release from any and all liability all representatives of Aacer Acquisition, LLC d/b/a Aacer Flooring for their acts performed in connection with evaluating my application, background, credentials and qualifications. I hereby further authorize any party (including the companies, schools and organizations listed in this application form) to release any information they may have about me to Aacer Acquisition, LLC d/b/a Aacer Flooring. I also release all persons, companies and schools (and all persons connected with them) who provide such information to Aacer Acquisition, LLC d/b/a Aacer Flooring from any and all liability for any damage for giving this information. I understand that if any of the information on this application form is discovered to be incorrect, false or misleading or if there are any misrepresentations or omissions of any kind whatsoever, then Aacer Acquisition, LLC d/b/a Aacer Flooring may deny me employment or terminate my employment, and I agree that Aacer Acquisition, LLC d/b/a Aacer Flooring shall not be liable in any respect if it does so.

I also understand that my employment at Aacer Acquisition, LLC d/b/a Aacer Flooring is contingent upon the receipt of satisfactory references and verification of all information provided as part of my application. I also understand that my employment at Aacer Acquisition, LLC d/b/a Aacer Flooring is contingent upon the satisfactory completion of a pre-employment drug screen and an investigation of my work record and references.

I understand that if I am employed by Aacer Acquisition, LLC d/b/a Aacer Flooring, any such employment is not binding on either party for any specific period of time. I further understand that no representative of Aacer Acquisition, LLC d/b/a Aacer Flooring other than an officer of the company, has any authority to enter into any agreement for employment for any specified period of time. Any such agreement must be in writing and signed by the officer of the company. I understand that any other written or oral statement to the contrary made by a supervisor or manager of Aacer Acquisition, LLC d/b/a Aacer Flooring is invalid and should not be relied on by me. I understand that if employed I will be an employee-at-will and that either Aacer Acquisition, LLC d/b/a Aacer Flooring or I may terminate that employment relationship at any time, for any reason, with or without notice.

Applicant's name: Date: //

We consider applicants for all positions on the basis of qualifications and without regard to race, color, religion, sex, national origin, age, marital status, veteran status, disability, sexual orientation and any other legally protected status.

AUTHORIZATION FOR REFERENCE CHECK

I am applying for employment with Aacer Acquisition, LLC d/b/a Aacer Flooring. I hereby authorize any and all persons (including any and all employers with whom I have been employed and schools that I have attended) to release any and all information they have about me to Aacer Acquisition, LLC d/b/a Aacer Flooring. This includes all of my personnel records with prior employers and any information about my performance during my employment with them and also includes all of my transcripts from any schools that I have attended. I hereby release all persons, companies and schools who provide such information to Aacer Acquisition, LLC d/b/a Aacer Flooring from any and all liability for any damage for giving this information.

This Authorization shall remain in effect for a period of one (1) year from the date on which I sign it. A photocopy of this Authorization may be used by Aacer Acquisition, LLC d/b/a Aacer Flooring and shall be as effective as the original.

Applicant's name: Date: //

Attach Résumé (optional, pdf, doc, or txt files less than 2MB):