Triple F Distributing

Employment Application

Application Information

Last Name First Name Middle Initial
Street Address Apt/Unit#
City State Zip
Phone Email
Date Available Applying for Desire Salary
Are you a citizen of the United States?  Yes No If no, are you authorized to work in the U.S.? Yes No
Have you ever worked for FFF Hawaii?  Yes No If so, when?
Have you ever been convicted of a felony?  Yes No If yes,explain

Education

Highschool Address Did you graduate?  Yes No
From To Degree
College Address Did you graduate?  Yes No
From To Degree
Other Address Did you graduate?  Yes No
From To Degree

References

Full Name
Relationship Company Phone
Full Name
Relationship Company Phone
Full Name
Relationship Company Phone

Previous Employment

Company Address Phone
Job title Starting Salary Ending Salary
From To Reason for leaving
Supervisor May we contact your previous supervisor for reference?  Yes No
Company Address Phone
Job title Starting Salary Ending Salary
From To Reason for leaving
Supervisor May we contcact your previous supervisor for reference?  Yes No
Company Address Phone
Job title Starting Salary Ending Salary
From To Reason for leaving
Supervisor May we contcact your previous supervisor for reference?  Yes No

Military Service

Branch From To
Rank Type If other than honorable, explain

Medical Information

Are you able to perform the functions of this job with or without reasonable accommodations?  Yes No
After an offer of employment is made (during the 60 day orientation) applicants will be required to undergo a drug srening test at Triple F Distributing expense and by a phusician chosen by Triple F Distributing. The offer of employment is on the result of such examination. Employees, at any time during the course of employement, may be required to undergo a drug screening test at Triple F Distributing and by a physician chosen by Triple F Distributing.

Do you authorize the physician conducting the exam and any lab testing an specimen obtained by the physician to disclose the results of the exam and lab test to Triple F Distributing?*  Yes No

Disclaimer and Agreement

By submitting this online application, I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.