Employment Application Online Rafael Lumber & Building Supply Online Application Rafael Lumber 930 Andersen Dr. San Rafael CA 94901 (415)456-3043 employment@rafael-lumber.com Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Alt. PhoneEmail Are you at least 18 years of age? (If under 18, hire is subject to verification of minimum legal age possessing a work permit)*Are you at least 18 years of age? (If under 18, hire is subject to verification of minimum legal age possessing a work permit) Yes No Do you have a legal right to work in the U.S.? (Proof of eligibility and identification required upon hire.)*Do you have a legal right to work in the U.S.? (Proof of eligibility and identification required upon hire.) Yes No If hired would you have a reliable means of transportation to and from work?*If hired would you have a reliable means of transportation to and from work? Yes No Are you able to perform the essential functions of the job for which you're applying, either with or without reasonable accommodations?*Are you able to perform the essential functions of the job for which you're applying, either with or without reasonable accommodations? Yes No If no, describe the functions that cannot be performed:(Note: We comply with the ADA and consider reasonable accommodations that may be needed for eligible applicants/Employees to perform essential functions. Hire may be subject to passing a medical examination, and skill and agility tests.)Have you ever applied to or worked for Rafael Lumber?*Have you ever applied to or worked for Rafael Lumber? Yes No If yes, when and where: Position Desired*Pick One:Window and Door SalesPlumbing SalesCounter SalesContractor SalesYard/Shed PositionPaint SalesElectrical SalesTool SalesHardware SalesCashierManagmentDelivery DriversRecievingSalary Desired Date available for Employment* MM slash DD slash YYYY Status Desired* Regular Full-Time (40 hrs) Regular Part-Time (20-39.9 hrs) Temporary Work Shift Desired* Day Swing Night Any Shift Available Weekends #1 Previous Employment* Name of Employer Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code From: & To:* Salary* Duties and Responsibilities*Reason for Leaving* Supervisors Name* #2 Previous Employment* Name of Employer Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code From: & To:* Salary* Duties and Responsibilities*Reason for Leaving* Supervisors Name* CommentsThis field is for validation purposes and should be left unchanged. Δ