Meek's Job Application Question Title * 1. Full Name Question Title * 2. What Meek's location are you applying to? (Select One) Berryville, AR Bolivar, MO Bourbon, MO Branson, MO Buffalo, MO Columbia, MO Doniphan, MO El Dorado Springs, MO Fayetteville, AR Greenfield, MO Jefferson City, MO Joplin, MO Kimberling City, MO Lebanon, MO Mexico, MO Monett, MO Mountain Grove, MO Mountain Home, AR Mt. Vernon, MO Neosho, MO Nevada, MO Nixa, MO Osage Beach, MO Poplar Bluff, MO Republic, MO Rogers, AR Rolla, MO Shell Knob, MO Springdale, AR Springdale, AR - Design Center Springfield, MO - East Sunshine Springfield, MO - Kansas Street Springfield, MO - Insulation & Drywall Springfield, MO - Design Center Springfield, MO - Corporate Office St. Robert, MO West Plains, MO Rogersville, MO (Modern Building Components) Question Title * 3. What position are you seeking? (Select One) Yard Staff Retail Sales Outside Sales Driver (Requires Class E License or Higher) Accounting/Bookkeeping Marketing (Springfield, MO Area Only) IT (Springfield, MO Area Only) Other (please specify) Question Title * 4. Today's Date Question Title * 5. Phone Number Question Title * 6. Email Address Question Title * 7. Your Address Street City State Zip Question Title * 8. Have you ever used another name? If so, please state names and dates: Name 1 Date 1 Name 2 Date 2 Question Title * 9. Salary: Salary Expected: Least Accepted: Question Title * 10. When could you start? Question Title * 11. Could you accept part-time work? Yes No Maybe Question Title * 12. If you answered "Yes" to part-time, what days or hours would you be available? Days: Hours: Question Title * 13. Do you have friends or relatives working at this company? No Yes (Who are they?) Question Title * 14. How did you learn about the job you are applying for? Question Title * 15. List 2 people that have known you at least 1 year that we may contact. Do not include relatives, former employers, or personnel of this company. Name 1 / Address / Occupation / Years Known / Telephone Name 2 / Address / Occupation / Years Known / Telephone Question Title * 16. Education: High School Name of High School Address Number of Years Attended Graduated? (Yes or No) Degree Average Grades Areas of Specialization Question Title * 17. Education: College Name of College Address Number of Years Attended Graduated? (Yes or No) Degree Average Grades Areas of Specialization Question Title * 18. Education: Other Please explain any other education or qualifications. Graduate Trade School Apprenticeships Other Question Title * 19. Work History #1 Company Name Address Phone Date Started Date Ended Job Title Name and Title of Supervisor Reason for Leaving Rate of Pay Duties Question Title * 20. Work History #2 Company Name Address Phone Date Started Date Ended Job Title Name and Title of Supervisor Reason for Leaving Rate of Pay Duties Question Title * 21. Work History #3 Company Name Address Phone Date Started Date Ended Job Title Name and Title of Supervisor Reason for Leaving Rate of Pay Duties Question Title * 22. Work History #4 Company Name Address Phone Date Started Date Ended Job Title Name and Title of Supervisor Reason for Leaving Rate of Pay Duties Question Title * 23. May we contact all of the employers listed? Yes No (Please Indicate whom you wish not to be contacted) Question Title * 24. Have you ever been convicted of, pleaded no contest to, or received a suspended imposition of sentence for a felony by any court or law (Federal, State, Military, Local)?(Note: Conviction for a felony will not necessarily disqualify you from employment with Meek's.) No Yes (please specify) Question Title * 25. Are you willing to take a complete physical examination at the expense of the company? Yes No Question Title * 26. Drivers License Drivers License # State Class Expiration Date Question Title * 27. Is your drivers license currently suspended? No Yes (please explain) Question Title * 28. List any traffic convictions you have had in the last 24 months (required in order to drive any company vehicle or equipment) Date / Violation Date / Violation Date / Violation Date / Violation Date / Violation Question Title * 29. Are you legally eligible to work in the United States?(The law requires you to provide us with proof of authorization for employment in the U.S. within 3 days of your hire date) Yes No Question Title * 30. AUTHORIZATION AND STATEMENT OF TRUTHFULNESS:"I CERTIFY THAT ALL OF THE INFORMATION I HAVE PROVIDED IS TRUE AND COMPLETE. I UNDERSTAND THAT ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS MAY RESULT IN MEEK'S BUILDING CENTERS (MEEK'S) DECLINING TO EMPLOY ME, OR, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED. I AGREE THAT IF I AM EMPLOYED, I WILL COMPLY WITH MEEK'S EMPLOYMENT POLICIES AND GUIDELINES AND THAT I UNDERSTAND THAT MEEK'S EMPLOYEES ARE EMPLOYEES "AT WILL," WHICH MEANS THAT EITHER I OR MEEK'S CAN TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON OR NO REASON AT ALL, WITH OR WITHOUT NOTICE. I UNDERSTAND THAT THE CONDITIONS AND TERMS OF MY EMPLOYMENT CAN BE CHANGED BY MEEK'S AT ANY TIME, WITH OR WITHOUT NOTICE. I ALSO UNDERSTAND THAT MEEK'S DOES NOT ENTER INTO EMPLOYMENT CONTRACTS UNLESS IT IS PLAINLY CAPTIONED "EMPLOYMENT AGREEMENT" AND IS SIGNED BY THE PRESIDENTOF THE COMPANY AND THE EMPLOYEE. NO OTHER MEEK'S EMPLOYEE HAS THE AUTHORITY TO VERBALLY OR IN WRITING ENTER INTO ANY EMPLOYMENT CONTRACT ON BEHALF OF MEEK'S." I Agree I Disagree Done