Jobs at Kimball Distributing Inc.

General Information

Date Available

Desired Compensation

Position Applied for
Full-TimePart-TimeTemporary

Are you a citizen of the United States? *
YesNo

Have you ever worked for this company? *
YesNo

Have you ever been convicted of or pled guilty, no contest or nolo contendere, or received deferred adjudication, pre-trial diversion or probation for any criminal offense (felony or misdemeanor), other than for a minor traffic violation? *
YesNo

Have you ever been involuntarily discharged from a position? *
YesNo

How were you referred to our company?

Have you had any driving accidents or traffic tickets for the last 5 years? *
YesNo

Have you completed a defensive driving course in the last 3 years? *
YesNo

Education

High School *

Address

From - To

Did you graduate?
YesNo

Degree

College

From - To

Did you graduate?
YesNo

Degree

Other

From - To

Did you graduate?
YesNo

Degree

References

Please list three professional and/or personal references.

Name*

Relationship*

Company

Phone*

Address

Name

Relationship

Company

Phone

Address

Name

Relationship

Company

Phone

Address

Previous Employment

Company

Phone

Address

Supervisor

Job Title

Starting Salary - Ending Salary

Responsibilities

From - To

Reason for Leaving

May we contact your previous supervisor for a reference?
YesNo

Company

Phone

Address

Supervisor

Job Title

Starting Salary - Ending Salary

Responsibilities

From - To

Reason for Leaving

May we contact your previous supervisor for a reference?
YesNo

Military Service

Branch

From - To

Rank at Discharge: If other than honorable, explain:

Type of Discharge

I hereby certify that the information provided on this application is accurate to the best of my knowledge and subject to verification by this company. I authorize the company, its affiliates and their representatives to investigate all information given and to secure additional job-related information, if necessary. I authorize an investigative report to be made whereby information is obtained through personal interviews with third parties, such as family members, business associates, financial sources friends, neighbors or others with whom I am acquainted. I understand and consent to an inquiry that may include information as to my character, general reputation, and personal characteristics, whichever may be applicable. This inquiry may include a review of social media information or activity. This information may also include, but is not limited to verification of previous employment, employment references, verification of education (including requests for transcripts), credit reports, motor vehicle driving records and criminal reports, etc. I hereby release from all liability or responsibility all persons companies, organizations or corporations furnishing such information.

I understand that any misrepresentation or omission of a material fact on my application will be justification for refusal of employment, or if employed, dismissal without advance notice.

In the event I am employed, I understand that all employees are subject to termination at the discretion of the company. If, in the event I choose to voluntarily terminate my employment, I am free to do so at any time, and, if I choose to give proper notice of termination, the company may either permit me to continue my employment during the notice period or may accept my resignation immediately.I understand that, in the event I am employed by the company, my compensation, hours of employment and all other terms and conditions of employment are subject to modification or change by the company at the company’s discretion.

I authorize the company to supply my employment record, in whole or in part, and in confidence, to any prospective employer, government agency, or other party, with a legal and/or proper interest.

In the event of my employment, I will comply with all rules and regulations as set forth in the company’s policy manual or other communications distributed to all employees.

I also understand that my employment is conditional upon my satisfactorily passing a drug and alcohol screening, if one is requested by Company, to be given by a physician, clinic or other health care provider selected by Company. I hereby authorize such physician, clinic or health care provider to share screening results with Company.

I understand that completion of this form does not guarantee me status as an applicant or any consideration for employment unless I meet all stated minimum qualifications required of the position for which I am asking to be considered.

I have read the above statement and accept it as conditions of application for employment with the company.

Signature *

Date *