Serving the Greater
Richmond VA Area

804.745.7927

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Employment Inquiry

EMPLOYMENT INQUIRY FORM

Thank you for your interest in obtaining a position with JKR Flooring, Inc.. The following is a simple inquiry form to see if it is in your interest to take the time to come in and fill out our normal employment application and potentially interview for possible employment.

All information submitted will be held in strict confidence. No phone calls will be made to your current or past employers without first talking to you. JKR Flooring, Inc. is a drug-free workplace and will conduct a background check on all employee prospects before hiring.

Contact Information

*First Name :

*Last Name :

Middle Initial:

*Address 1:

Address 2:

*City:

*State:

*Zip Code:

*Home Phone #:

Personal Cell Phone #:

*E-mail:

*Confirm E-mail:

Do you have a valid Driver's License?: Yes No

*Type of Work Desired:

*Days / Hours Available:

Have you applied with us before: If Yes, When:

Education & Certifications

High School

Number of years attended:

Did you graduate: Yes No

Name and Location of School:

Subjects Studied:

College

Number of years attended:

Did you graduate: Yes No

Name and Location of School:

Subjects Studied:

Trade or Business School

Number of years attended:

Did you graduate: Yes No

Name and Location of School:

Subjects Studied:

Current Certifications and Licenses:

Have you ever been convicted of a felony?

If yes, please provide details:

Employment History

Company Name:

Date From - Date To

-

Starting pay rate $ Hourly Monthly Annually

Ending pay rate $ Hourly Monthly Annually

Duties:

Reason for Leaving:

Name of Supervisor:

Supervisor's Title:

Supervisor's Phone # or reason to not contact:

Company Name:

Date From - Date To

-

Starting pay rate $ Hourly Monthly Annually

Ending pay rate $ Hourly Monthly Annually

Duties:

Reason for Leaving:

Name of Supervisor:

Supervisor's Title:

Supervisor's Phone # or reason to not contact:

Company Name:

Date From - Date To

-

Starting pay rate $ Hourly Monthly Annually

Ending pay rate $ Hourly Monthly Annually

Duties:

Reason for Leaving:

Name of Supervisor

Supervisor's Title:

Supervisor's Phone # or reason to not contact:

References

Reference 1 Name:

Reference 1 Phone Number:

Reference 2 Name:

Reference 2 Phone Number:

Reference 3 Name:

Reference 3 Phone Number:

Additional Skills

Other Skills:

Special Training :

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