This in not an offer of employment
(Must be 18 years of age or older to apply)


NAME:_____________________________________SOCIAL SECURITY:________-______-________
        (Number and Street)                                    (City)                                                       (Zip Code)
PHONE NUMBER:(______)_______________________ALT#:(_____)__________________________
Email address:______________________________________________________________________
REFERRED BY:__________________________________

Have you ever been convicted of a felony? Yes____No____



___Lead Installer*     ___Installation Helper*     ___Yard*     ___Wood Shop*
___Steel Shop*          ___Office          ___Sales (inside)          ___Sales (outside)
*These positions require that you routinely stoop and bend and lift and carry 100 pound loads. Specialty clothing and
personal tools  are required. All positions require strict compliance to our clothing and conduct codes. Hazardous
materials may be present - Material Data Sheets are available - see Compliance Poster at time clock for  location.
Random substance screening is a condition of all pre-employment and subsequent employment. By attaching your
signature to this document you certify that you understand and currently comply with and expressly agree to all of these
conditions; and will continue to agree with and comply with these conditions should you subsequently be employed by
Modern Fence Company, to the extent not limited by law.

Have you worked for us before? Yes_____No_____ if Yes, when/position?_______________________
Are you presently employed? ___Yes  ___No    if Yes, please complete the following:

Employer's Name___________________________________________________________________
Employers Phone Number (_____)_________________________ Supervisor____________________
Your Job Title/Duties/Responsibilities____________________________________________________
1.) How long with this employer?____________________________Present salary________
2.) If offered a position, when can you report for work?______________________________
3.) If hired, can you provide proof of your ability to legally work in the U. S.? Yes  ____No____
4.) Have you ever been dismissed or asked to resign from any position? Yes  ____No____
If Yes, please explain:_________________________________________________________

1.) Last Employer:______________________________________Supervisor:_________________
  Job description/duties:___________________________________________________________
  Reason for leaving:_____________________________________________________________

2.) Next Employer:______________________________________Supervisor:_________________
  Job description/duties:___________________________________________________________
  Reason for leaving:_____________________________________________________________

Please list schools attended. Use the blank line for any special training or other pertinent information
Grade School:____________________________________________City:_____________________
High School:______________________________________________City:_____________________
Specialized Training:________________________________________________________________


1.   Name __________________________Relation:______________Phone:(____)______________
2.   Name __________________________Relation:______________Phone:(____)______________
3.   Name __________________________Relation:______________Phone:(____)______________

I certify that all information furnished on this Application is true, complete and correct, to the best of my knowledge. I
understand and agree that any falsification, misrepresentation, or omission of fact either on this Application or during
the pre-hire process will be reason for (1) my not being offered employment and/or (2) dismissal at any time from the
service of Modern Fence Company, if so employed.

I authorize Modern Fence Company to contact my present and/or former employer(s) and references and further
authorize my references and  my present employer and my former employer(s) to provide any and all information they
have regarding me, whether or not part of their permanent record. I hereby release my references, my present and my
former employer(s), their companies and persons (and their agents individually) from any and all liability whatsoever
resulting from the release of such information. I hereby waive my right to written notice by my present and/or former
employer(s) whenever a disciplinary report, letter or reprimand, or other disciplinary action regarding me divulged to you
by my present and/or former employer(s).

If I am so employed, I agree to conform to the policies and procedures of Modern Fence Company. I understand and
agree that my employment and compensation is for no definite period and may, regardless of the time and manner of
payment of my wages and salary, be terminated at any time by me or Modern Fence Company with or without cause,
and without any without any prior notice. I also understand and agree that Modern Fence Company retains the right to
unilaterally modify and/or terminate any policies, practices, procedures and standards it has adopted or implemented, to
the extent not limited by law. I acknowledge that no Modern Fence Company employee or representative has the power
or authority to enter into any agreement for employment for any specified time period, or to make any representations or
agreements contrary to at-will employment. I understand and agree that any prior representations, promises, contracts
or statements made by or on behalf of Modern Fence Company are expressly superseded by this paragraph as
confirmed by my signature below.
I have read the foregoing provisions and agree to be bound by them.
All of the above is to be construed as to being to the extent not limited by law.