Application for Employment

Phone: 510 237-4447; Fax: 510 237-1409; 11835 San Pablo Avenue; El Cerrito, CA 94530

House of Carpets is an equal opportunity employer. We do not discriminate on the basis of race, class, sex or religion.

This form is a pre-employment questionnaire. Please fill in all information to the best of your ability.

All information will be submitted over a secure connection.

Personal Information
Name:	(Last name first)
Social Security Number:
Present Address:	,
Permanent Address:	,
Phone:	include area code
email address:
Referred By:
Employment Desired
Position:
Date you can start:
Salary Desired:
Are you Employed?:	Yes \| No
If so, may we inquire of your present employer:	Yes \| No
Ever applied to this company before?:	Yes \| No
If so, when?:
Education History
Grammar School:
Name and Location:
Years Attended:
Did you Graduate?:	Yes \| No
Subjects Studied:
High School:
Name and Location:
Years Attended:
Did you Graduate?:	Yes \| No
Subjects Studied:
College:
Name and Location:
Years Attended:
Did you Graduate?:	Yes \| No
Subjects Studied:
Other School: Trade, Business or Correspondence
Name and Location:
Years Attended:
Did you Graduate?:	Yes \| No
Subjects Studied:
General Information
Subjects of Special Study/Research, Work or Special Training, Skills:

U.S. Military or Naval Service:
Rank:
Former Employers: list last four employers, starting with last one first
Most recent employer:
Date Started:
Date Ended:
Name and Address:
Salary:
Position:
Reason for Leaving:
Second employer:
Date Started:
Date Ended:
Name and Address:
Salary:
Position:
Reason for Leaving:
Third employer:
Date Started:
Date Ended:
Name and Address:
Salary:
Position:
Reason for Leaving:
Fourth employer:
Date Started:
Date Ended:
Name and Address:
Salary:
Position:
Reason for Leaving:
References: Give the names of thre persons not related to you whom you have known at lesat one year.
First Reference:
Name:
Address:
Business:
Years Known:
Second Reference:
Name:
Address:
Business:
Years Known:
Third Reference:
Name:
Address:
Business:
Years Known:
Authorization:
"I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liaability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant and federal state laws."
By entering your full name and date below, you agree to the above statement of authorization.
Full Name:
Date of Authorization:
Submit Information:
Please look over the information you have entered above. When you are certain the information is correct, click on the "Submit Application" button that appears below. Thank you for your interest in working for the House of Carpets.