Personal Information


 Yes     No
 Yes     No

Employment Desired


 Yes     No
 Yes     No
 Yes     No

Education


High School:

School Name and Location:
Years Attended:
Did You Graduate:
Subjects Studied:

College:

School Name and Location:
Years Attended:
Did You Graduate:
Subjects Studied:

Trade, Business or Correspondence School:

School Name and Location:
Years Attended:
Did You Graduate:
Subjects Studied:

General:


Employment History


Employer 1:


Employer 2:


Employer 3:


Employer 4:


References


Reference 1:

Name:
Address:
Business:
Years Acquainted:

Reference 2:

Name:
Address:
Business:
Years Acquainted:

Reference 3:

Name:
Address:
Business:
Years Acquainted:

Emergency Contact


In case of emergency notify:
Emergency home:
Emergency cell:
Emergency work:

  I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentation are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its President or Vice President, and then only when in writing and signed by the President, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

Supreme Industries, Inc. - An Equal Opportunity Employer. 216 Bogue Road, Harwinton, CT 06791 - 860-485-0343

Note: CDL Drivers, if considered for employment you will be asked to provide a copy of license and DOT medical card.