THE GARLAND COMPANY, INC.
* 3800 East 91st Street * Cleveland, Ohio 44105 * (216) 641-7500
PERSONAL DATA SHEET
The Garland Company provides an equal opportunity in the selection of applicants and advancement of employees. Individuals are considered for employment on the basis of their qualifications without regard to race, color, religion, age, sex, national origin, disability, veteran status or other category protected by applicable law.

* = Required Field
Date of Application
07/30/2010
General Information
* Last Name* First NameMiddle Name


* Address* City* State* Zip Code


Telephone Number(s)
* Home: Cell Phone:
Work:
Can you receive calls at work? 		E-Mail Address:


* Position(s) Applied For:Approximate income required:
Are you legally eligible for employment
in the United States?


Do you know of any reason why you should not be able to perform the job for which you are applying, with or without accommodations?
If Yes, explain:


Willing to travel?
Willing to relocate?


How did you learn about us?

Explain:


Driver's License No. State Issued in: S.S. #:


Have you pled guilty to, pled no contest to, or been convicted of a crime including any driving related misdemeanor within the last 10 years? **See Note Below
A conviction record does not automatically bar you from employment. All job-related circumstances will be considered.
If yes, please describe the offense, its disposition, the city and state, and the date:

**Applicants: When completing this section, do not disclose information regarding convictions that have been judicially sealed or expunged.
Applicants in California: Do not disclose information regarding any referral or participation in a pre or post-trial diversion program and do not disclose information regarding any marijuana-related convictions under the Calif. Health and Safety Code ยงยง11357(b)-(e) or 11360(b0 that are more than 2 years old.
Applicants is Georgia: Do not disclose any first offender discharge under Georgia law.
Applicants in Massachusetts: Do not disclose information regarding misdemeanor convictions or completion of any incarceration that is more than 5 years old and first convictions for drunkenness, simple assault, an affray, or disturbing the peace.
Applicants in Nevada: Do not disclose misdemeanor convictions that did not result in imprisonment.

Educational Background

High SchoolUndergraduate College/UniversityGraduate/Professional
School Name
Location
Years Completed 9 10 11 12 1 2 3 4 1 2 3 4
Degree Granted
GPA

College Major:
College Minor:
Percent of Expenses Earned (%)

Scholarships, honors, etc.
Activities, offices held, when?
What were your goals in school?
What was your outstanding school achievement(s)?
What were your favorite subjects in school? Why?
What were your least favorite subjects in school? Why?
List any additional training or seminars you have taken.

Armed Forces Record

Branch Final Rank
Present Status No. of Years Active

Primary Duties
What did you like best about your military service?


Employment Experience

Start with most present or most recent job first. Give exact dates. Answer all questions even if submitting a resume.

Job #1
Employer Name:

Address:

Telephone Numer(s):

Position(s):
Supervisor:
From Mo/Yr:
To Mo/Yr:
Total Earnings Start:
Total Earnings Final:
% Salary:
% Commission:

Describe Work Performed/Duties:
Reason for Leaving:
Why did you want to work for this company:

Job #2

Employer Name:

Address:

Telephone Numer(s):

Position(s):
Supervisor:
From Mo/Yr:
To Mo/Yr:
Total Earnings Start:
Total Earnings Final:
% Salary:
% Commission:

Describe Work Performed/Duties:
Reason for Leaving:
Why did you want to work for this company:

Job #3

Employer Name:

Address:

Telephone Numer(s):

Position(s):
Supervisor:
From Mo/Yr:
To Mo/Yr:
Total Earnings Start:
Total Earnings Final:
% Salary:
% Commission:

Describe Work Performed/Duties:
Reason for Leaving:
Why did you want to work for this company:

Job #4

Employer Name:

Address:

Telephone Numer(s):

Position(s):
Supervisor:
From Mo/Yr:
To Mo/Yr:
Total Earnings Start:
Total Earnings Final:
% Salary:
% Commission:

Describe Work Performed/Duties:
Reason for Leaving:
Why did you want to work for this company:

Job #5

Employer Name:

Address:

Telephone Numer(s):

Position(s):
Supervisor:
From Mo/Yr:
To Mo/Yr:
Total Earnings Start:
Total Earnings Final:
% Salary:
% Commission:

Describe Work Performed/Duties:
Reason for Leaving:
Why did you want to work for this company:

Job #6

Employer Name:

Address:

Telephone Numer(s):

Position(s):
Supervisor:
From Mo/Yr:
To Mo/Yr:
Total Earnings Start:
Total Earnings Final:
% Salary:
% Commission:

Describe Work Performed/Duties:
Reason for Leaving:
Why did you want to work for this company:

Job #7

Employer Name:

Address:

Telephone Numer(s):

Position(s):
Supervisor:
From Mo/Yr:
To Mo/Yr:
Total Earnings Start:
Total Earnings Final:
% Salary:
% Commission:

Describe Work Performed/Duties:
Reason for Leaving:
Why did you want to work for this company:

Job #8

Employer Name:

Address:

Telephone Numer(s):

Position(s):
Supervisor:
From Mo/Yr:
To Mo/Yr:
Total Earnings Start:
Total Earnings Final:
% Salary:
% Commission:

Describe Work Performed/Duties:
Reason for Leaving:
Why did you want to work for this company:

Other Employment Information
Explain any period of unemployment:
Were you ever fired?
Why?
Which job did you like the best?
Why?
Which job did you like the least?
Why?
In which job did you accomplish the most? What did you do?
Which supervisor did you like the most? Why?
How did you choose your occupation?
Why are you interested in this position?
Describe what you would consider the ideal working conditions?
What do you hope to find in your next job?


References (managers or associates who can be contacted when a mutual interest is established)

Give two references of successful business people
NameBusiness or ProfessionPositionAddressPhoneYears Known


General Information

What has been your most successful accomplishment to date?
What did you do to improve yourself last year?
To what do you attribute your success so far?
What are the qualities of an ideal supervisor?
What goals have you set for the future?
What do you believe are your strongest personal qualities?
What do you believe are your weakest personal qualities?

PLEASE READ CAREFULLY

If hired, I agree to provide any proof of ability to work in the United States asrequired by law. I affirm that all statements and answers are true and correct to the best of my knowledge, and that I have not knowingly withheld any information requested. I understand that any false statement or omissions may be considered sufficient cause for rejection or dismissal.

I understand and agree that, as a part of the hiring process I will submit to a medical/physical examination (which will include tests for drugs and/or alcohol) and, if hired, I may be required to submit to medical/physical examinations that are job-related and consistent with business necessity.

I hereby release previous employers and The Garland Company Inc. from all liability for any damage whatsoever arising from obtaining information of my past employment performance. I also authorize investigation of all statements in this application.

I further agree that in consideration of Garland Industries, Inc.'s review of my application, any claim or lawsuit arising out of my employment with, or my application for employment with Garland must be filed no more than 300 days after the date of the employment action that is the subject of the claim or lawsuit. While I understand that the statute of limitations for claims arising out of an employment action may be longer than 300 days, I agree to be bound by the 300 day period of limitations set forth herein, and I WAIVE ANY STATUTE OF LIMITATIONS TO THE CONTRARY.

I understand that this application is not offer for employment or an employment contract and it will not obligate the employer in any way if I am hired. I also understand that, if hired, my employment and compensation will be at the will of Garland Industries, Inc. and can be terminated, with or without cause, and with or without notice, at any time at the option of either Garland or myself.

Electronic Signature


Signature _________________________ Date ________________