List all full and part time jobs you have had in the past 7 years. Include any job related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, sex, national origin, handicap or other protected status. *Please list full and part time jobs you have had over the past 7 years, listing your most recent job FIRST. (Alternatively, you may attach a current resume, if you wish.)

Please list the names of persons not related to you willing to provide professional or character references for you. Give name, address and telephone number.

Please include: 1) grammar school, high school, college and other education. 2) Names & locations of schools 3) Did you graduate? 4) Years attended and degree or diploma, if relevant.

"I certify that answers given herein are true and complete to the best of my knowledge.” I understand that I may be required to submit to a post-employment offer physical examination and/or a drug screen, and that employment is conditioned upon obtaining satisfactory results. I consent to this post-employment offer physical examination and such further examinations as may be required, which may include drug screenings. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In conjunction with my potential employment at LaValley/Middleton Building Supply, I (the applicant) consent to the release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review, evaluation, and other use of any MVR I may have provided to the company. This consent is given in satisfaction of Public Law 18 USC 2721 et. Seq., “Federal Drivers Privacy Protection Act”, and is intended to constitute “written consent” as required by this Act. I understand that, if hired, any employment relationship with this Company is of an “at-will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. I also understand that acceptance of an offer of employment does not create a contractual obligation to continue to employ me in the future and that no Company official, management or otherwise, is authorized to make any oral assurance or promise of continued employment, and that any such pledge or agreement must be in writing, signed by the President of the Company. I the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.