Contact Information

Education / Skills

Employment History

List last employer first, include military experience and explain any unemployment over 30 days ( Please do not reference resume. )

Employer 1

Period of Unemployment

Employer 2

Period of Unemployment

Employer 3

Period of Unemployment


List below three references who are not relatives and over the age of 21 whom have known you for 5 years or more.


DIRECTIONS: Read the following Statement and Acknowledgement carefully before you sign this application. If you have questions or need assistance in reading or understanding this Statement and Acknowledgement, please ask the human resources representative assisting with your application.

  1. I certify that the information contained in this application is correct the best of my knowledge, and understand that intentional falsification of this application in any detail is grounds for disqualification from any further consideration for or dismissal from employment. I authorize the Company or its designee to investigate all statements and references in this application and release the Company and its agents from any and all liability resulting from such investigation. This includes that authorization for the Company to contact my present and past employers (if checked above) to obtain reference information and to conduct other inquiries into my background. I agree to execute any additional authorizations or consent forms, which may be required for such inquiries to be done.
  2. In the event that Locke Supply Co. offers a position of employment to me, I agree to conform to the rules and regulations of the Company, and I understand that, if I am employed, my status will be that of an employee-at-will. I further understand that, as an employee-at-will, my employment and compensation can be terminated, with or without cause, at any time, at the option of either the Company or myself. I further understand that no one with the Company is authorized to enter into an oral agreement for employment for any specified period of time or on any other basis than employment-atwill. I understand that any agreement contrary to the foregoing must be in writing and signed by both an authorized officer of the Company and myself.
  3. I understand that I will be requested to take a post-offer drug and/or alcohol test and that my commencement of employment will be contingent on passing that test. I understand that if the drug test is initially positive, I will be allowed an opportunity to discuss the results with the Company’s Medical Review Officer before the test results are reported to the Company; however, a positive test confirmed by the Medical Review Officer will result in withdrawal of any job offer. Compliance with Locke Supply Co. drug/alcohol policy and testing program is a condition of employment. Any new applicant who refuses to submit to a drug/alcohol test will not be eligible for employment.
  4. I further authorize Locke Supply Co. to request a copy of my driving record. I realize two or more moving violations will disqualify me for employment in the branches. I acknowledge that I have read, or had read to me, the Statement and Acknowledgement above, that I have had any questions about the above information answered and that I understand it.
  5. All branch and warehouse associates are subject to lifting heavy objects. This could be as much as 100lbs (with assistance). Please indicate below whether you are capable of heavy lifting.


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