Application for Employment: Part 1

To Our Applicants:

Please answer all questions completely. If you need help in completing this application, please request assistance from a member of this office. We will be pleased to serve you. We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, national origin, sex, marital status, pregnancy, age, disability or other protected status. Information provided on this application will not be used for discriminatory purposes. You may attach a résumé but must complete all sections of this form. Your application is current for only 30 days. if you have not heard from us by that time and still wish to be considered, you must fill out a new application.

By making this application you are certifying and assuring that you are a genuine applicant for employment and are actively seeking and available for employment, that you are the person you claim to be; and that you are not submitting this application for any subterfuge or other reason or under any false pretenses.

You must have cookies enabled on your web browser to use this application process. If you do not have cookies enabled, you may email your résumé to our Human Resources Department.

The Next Day Blinds Application process should take approximately 30 minutes or less. Unfortunately, once you have started, there is no option to save and come back at a later time. Please plan your time accordingly.

Today's date:
Document Number: 764346104

All fields are required. If you are unable to provide the requested information, or it is not relevant, please enter "NA".

Personal Data

Your Name:
XXX-XX-
Present Address:
Street: City:
State: Zip Code:
Phone:
Alternate Phone:
Email:
Previous locations at which you have lived: Other names under which you have been known:
Position applied for: (please select at least one position)
 Installation/Measuring  Production  Customer Service  In-home Sales  In-store Sales  Warehouse
 Administration  Human Resources  Accounting/Finance  Marketing  Information Technology  Corporate (Various)
Salary expected: Date you can start:
Schedule you are available to work:
Would you work?   
Referred by:
Were you previously employed by us?   
If yes, when?
Do you have the legal right to be employed in the U.S.?   
Visa number (if any): Expiration date:
Person to be notified in an emergency:
Name: Address:
Phone:
Please list any friends or relatives who are working for us:
Name(s): Relationship:
Meeting expectations: Please ask if you are not sure where and when you will be expected to report.
Do you have reliable transportation to and from work?   
Can you meet the reporting requirements and
work schedule of the job for which you are applying?
  

Employment

Starting with present or most recent, list ALL PREVIOUS EMPLOYERS. Include self-employment, summer and part-time jobs. If more space is required, please continue on separate sheet. If you worked under a different name, give the name you used.
Last or present company:
Name of company: Job title:
Street: City:
State: Zip Code:
Supervisor's name & title: Phone:
Starting salary: Ending salary:
Dates worked:
From:
To:
Reason for leaving:
State whether separation from job was involuntary and the reasons for such terminations.
Brief description of job duties:
Name of company:
Name of company: Job title:
Street: City:
State: Zip Code:
Supervisor's name & title: Phone:
Starting salary: Ending salary:
Dates worked:
From:
To:
Reason for leaving:
State whether separation from job was involuntary and the reasons for such terminations.
Brief description of job duties:
Name of company:
Name of company: Job title:
Street: City:
State: Zip Code:
Supervisor's name & title: Phone:
Starting salary: Ending salary:
Dates worked:
From:
To:
Reason for leaving:
State whether separation from job was involuntary and the reasons for such terminations.
Brief description of job duties:
Upload your résumé: MS Word (.doc), Adobe PDF(.pdf) or Rich Text Format (.rtf). Please make certain the file size of your résumé is less than 20mb.

Military Record

Branch of service:
Indicate your rank, duties and special training:

Date entered:
Date discharged:
Type of discharge:

Education & Training

Type of school: Complete name and
address of school
Major fields of study Did you graduate? Type of diploma, degree,
or certificate
High school or
equivalency certificate




Vocational, technical,
community,
and junior colleges




Colleges and
universities




Skills and Qualifications:
Summarize any special training, skills, licenses or certificates that may relate to the job for which you are applying:
Computer / Technology Skills: (Please describe)
Word processing: Years:
Internet usage and searches: Years:
E-mail: Years:
Development: Years:
Spreadsheet: Years:
PowerPoint or other presentation: Years:
Other: Years:
Do you have a current legal driver's license? (If yes, indicate class)
 Yes    No
 Car        Light Duty Trucks        Trucks with Trailers        Commercial Drivers License
Endorsements/Restrictions:
*Background Information: For what crimes or offenses have you been charged, placed on probation, or convicted (including minor traffic violations if applying for a position involving operation of any vehicle)? (A charge or conviction will not necessarily prevent consideration or acceptance of your application, but certain aspects of our business such as access to customer homes, customer's private information, or company assets require us to determine whether your record is job related. Failure to be truthful will be grounds to reject your application or to discharge you. Expunged arrests or convictions need not be reported). Please give details including offense, date, location, circumstances and disposition for each charge, probation and/or conviction:
Other job related information you wish to describe:

References

List three persons who are not related to you and who have knowledge of your qualifications.
Full name Years known Present business or home address
(No.,Street, City, State, Zip code)
Business or occupation Telephone















Agreements Restricting Your Employment

Have you entered into a non-competition, non-solicitation or non-disclosure/confidentiality agreement or any other agreement with a current or former employer that may impact your ability to do work for the Company?
 Yes    No *If yes, identify the Employer(s):
Please provide a copy of the agreement.