Fillable Printable Harbor Freight Application Form

Harbor Freight Application Form

Have you been convicted of a misdemeanor or felony

in the last seven years? Yes No If yes,

please explain:

HARBOR FREIGHT TOOLS

Application For Employment (NOT an offer for employment)

Please Print in Ink

NAME

Last First Middle

TELEPHONE NO. 1 ( ____ ) _______________

ADDRESS

Street City State Zip Code

Are you under 18? Yes No

TELEPHONE NO. 2 ( ____ ) _______________

If Yes, do you have (or will you get) a work permit? Yes No

POSITION APPLIED FOR _________________________________________________ DATE _____________

Can we leave a message to contact you? Yes No

Are you eligible for employment in this country? Yes No (Proof of eligibility will be required upon employment)

Have you been employed by this company before? Yes No Does your relative work here? Yes No

Are you currently employed? Yes No When can you start work here? _______________

Type of Employment Desired: Full Time Part Time Temporary

Shift Desired: Day Evening Night

Are you willing to work overtime if required?

Hours available to work: *

Mon. Tue. Wed. Thur. Fri. Sat. Sun.

From

Yes No

Note: Please print your responses and sign this application in ink. Individuals will not be considered an

applicant if they exclude 1.) position applied for and date, 2.) information required by law such as authorization

to work in the U.S., 3.) a complete employment history including name of employer, dates of employment, rate

of pay and reason for leaving, and 4.) signature of applicant.

Equal Opportunity: All

applicants will be given equal

consideration regardless of race,

age, sex, physical or mental

disability, sexual orientation,

ancestry, pregnancy, or other

medical condition, marital status,

color, religion, national origin, or

veteran

status.

Are you able to perform the essential functions of the job applied for with or without reasonable

accommodation?

For retail/warehouse, typical job functions in this company involve employees to bend, squat, kneel twist, work at heights

intermittently, pushing and pulling of materials, reaching and working above and below shoulder level, lift and carry items weighing 25 to 75 pounds,

work cordially with the public. For office, duties involve sitting continuously throughout the day; simple grasping, pushing, and pulling of materials;

stand, walk, bend squat and kneel intermittently; operate computer keyboards and 10-key calculator throughout the day; lift and carry items up to 25

lbs.; read written communications and understand verbal communication over the phone. Are you able to perform? Yes No If no, please

explain. Attach extra sheet as necessary. Do not provide medical information.

* Please note: Regardless of work schedules, regular and prompt attendance is required of all employees and is an essential function of all positions.

_________________________________________________________________________________________

IN CASE OF EMERGENCY NOTIFY:

__________________________________________________________________________________________

Name Address City State Phone

If yes, phone no. ____________________

Application for Employment HARBOR FREIGHT TOOLS Page1 1/06

PERSONAL REFERENCE: Provide the name of one person, not related to you, whom you have known for at least one year.

_________________________________________________________________________________________________________________

Name address city state phone No. years known

Note: Convictions do not automatically disqualify an applicant

from further consideration. However, offers of employment (or the

continued employment of newly hired employees) are contingent

upon criminal, background, and for some positions, credit

investigation findings which conform to overall company hiring

standards or are applicable to specific position requirements.

How Did You Learn of this Position? Newspaper School Walk-in Referral (Name _______________)

Employer ____________________________________ Telephone (_____) _________________ Dates Employed: From ____________ To ____________

Address ______________________________________________________________________________________________________________________________

street city state zip code

Job Title _______________________________________________ Starting hourly rate/salary: $__________ Final hourly rate/salary: $___________

Immediate Supervisor Name/Title _______________________________ Telephone # (_____) _______________ May we contact this person for a reference? Yes No

Summarize the nature of your work and your duties _____________________________________________________________________________________________

______________________________________________________________________________________________________________________________________

Why did you leave this employer?

Employer ________________________________________ Telephone (_____) _________________ Dates Employed: From ____________ To ___________

Address ______________________________________________________________________________________________________________________________

street city state zip code

Job Title _______________________________________________ Starting hourly rate/salary: $__________ Final hourly rate/salary: $___________

Immediate Supervisor Name/Title _______________________________ Telephone # (_____) _______________ May we contact this person for a reference? Yes No

Summarize the nature of your work and your duties _____________________________________________________________________________________________

Why did you leave this employer?

Employer ________________________________________ Telephone (_____) _________________ Dates Employed: From ____________ To ____________

Address ______________________________________________________________________________________________________________________________

street city state zip code

Job Title _______________________________________________ Starting hourly rate/salary: $__________ Final hourly rate/salary: $___________

Immediate Supervisor Name/Title _______________________________ Telephone # (_____) _______________ May we contact this person for a reference? Yes No

Summarize the nature of your work and your duties ______________________________________________________________________________________________

Why did you leave this employer?

NAME_________________________________ Page 2 1/06

EDUCATION (Circle the last year completed)

Elementary School 5 6 7 8

High School 1 2 3 4

College 1 2 3 4

Highest degree obtained: ______ Name of school/college: __________________

Describe other training or education:

_________________________________________________________

___________________________________________________________

Describe office/warehouse equipment you

can operate (i.e. forklifts, computers, etc.)

______________________________________

_________________________________

EMPLOYMENT HISTORY —- List your three most recent employers, starting with the most recent, including military

experience. Please explain gaps in employment in the COMMENTS section below.

(If necessary, to account for for all

experience within the last 10 years, also complete Supplement to Application for Employment.)

COMMENTS: (Explain ALL gaps in employment)

Please read and sign:

I hereby certify that the information in this application is true and correct to the best of my knowledge and agree to have any of

the information verified by this organization unless I have indicated in writing to the contrary. I authorize the references listed

above, as well as other individuals who the company or the company’s agents contacts, to provide any and all information

concerning my previous employment and any other pertinent information that they may have. Further, I release all parties and

persons from any and all liability for any damages that may result from furnishing such information to the company as well as

from the use or disclosure of such information by the company or any of its agents, employees, or representatives. I understand

that any misrepresentation, falsification, or material omission of information on this application may result in my failure to

receive an offer or, if I am hired, my immediate dismissal from employment. I agree to conform to the rules and standards of

the company, as amended from time to time at its discretion. I agree that my employment and compensation can be terminated

at will, with or without cause, and with or without notice, at any time, either at my option or at the option of the company. I

understand that the company reserves the right to search all employees/persons and all parcels, packages, lunch boxes, coats,

bags, containers, lockers, boxes and belongings, etc. on property controlled by the company at all times. The aforementioned

right-to-search is a condition of employment. No written or oral promise of employment for a specified term is effective unless

expressly set forth in a document signed by an officer of the company. I understand that I am advised not to resign current

employment until after an official offer of employment by this company is extended. It is company policy to provide an

environment free of discrimination or sexual harassment and if any such discrimination or harassment takes place, I will report

it to a manager or a personnel representative immediately. I hereby acknowledge that I have read and fully understand the

above statements, including the statement concerning company rules and the “Right-to-Search” statement.

NAME OF APPLICANT (Print) ___________________________________________________________

SIGNATURE OF APPLICANT

__________________________________________________ DATE ___________________

HARBOR FREIGHT TOOLS —- APPLICATION FOR EMPLOYMENT

Company use only: Reviewer signature______________________ Manager signature_____________________________date______

21719/3

(This is a supplemental sheet which references and incorporates all information, instructions, authorizations, and provisions

of Applicant's completed Application for Employment.)

SUPPLEMENT TO APPLICATION FOR EMPLOYMENT

HARBOR FREIGHT TOOLS -

EMPLOYMENT HISTORY - Continued from

Application For Employment

Form

— Applicant: Use as many of these

sheets as is necessary to account for the LAST 10 YEARS of your work experience. Please explain gaps in employ-

ment in the comments section below (or on an additional/separate sheet).

APPLICANT NAME (PRINT)

Employer___________________________________Telephone ( )___________________________Dates Employed: From_________To________

Address___________________________________________________________________________________________________________________

Job Title____________________________________Starting hourly rate/salary: $________________Final hourly rate/salary $__________________

Immediate Supervisor Name/Title__________________Telephone ( )_______________May we call this person for a reference? Yes No

Summarize the nature of your work and your duties________________________________________________________________________________

__________________________________________________________________________________________________________________________

Why did you leave this employer?______________________________________________________________________________________________

street city state zip code

COMMENTS: (Explain all gaps in employment)

_________________________________________________________________________________________________

THIS IS SHEET_____OF_____SHEETS SUBMITTED AS SUPPLEMENT TO APPLICATION FOR EMPLOYMENT

SIGNATURE OF APPLICANT______________________________________________DATE______________________

Employer___________________________________Telephone ( )___________________________Dates Employed: From_________To________

Address___________________________________________________________________________________________________________________

Job Title____________________________________Starting hourly rate/salary: $________________Final hourly rate/salary $__________________

Immediate Supervisor Name/Title__________________Telephone ( )_______________May we call this person for a reference? Yes No

Summarize the nature of your work and your duties________________________________________________________________________________

__________________________________________________________________________________________________________________________

Why did you leave this employer?______________________________________________________________________________________________

street city state zip code

Employer___________________________________Telephone ( )___________________________Dates Employed: From_________To________

Address___________________________________________________________________________________________________________________

Job Title____________________________________Starting hourly rate/salary: $________________Final hourly rate/salary $__________________

Immediate Supervisor Name/Title__________________Telephone ( )_______________May we call this person for a reference? Yes No

Summarize the nature of your work and your duties________________________________________________________________________________

__________________________________________________________________________________________________________________________

Why did you leave this employer?______________________________________________________________________________________________

street city state zip code

HARBOR FREIGHT TOOLS 1/04

KP 7/10

Check America, Inc.

P.O. Box 5615

Riverside, CA 92517 USA

Call Toll free: 877-345-

2021

Call Direct: 951-750-

1501

Fax: 951-750-

1697

Instant Access to a

World of Information!

Authorization for

Background Investigation

File # (online users only): ______________

To Whom It May Concern:

I, ____________________________________, hereby authorize A-Check America, Inc. and/or its agents to make

an independent investigation of my background, which may include my character, general reputation, personal

characteristics, or mode of living in connection with an application of employment with Harbor Freight Tools.

The Scope of the report may include information concerning my driving record, civil and criminal court records,

credit, workers’ compensation record, education, credentials, identity, past addresses, social security number,

previous employment, and personal references.

I authorize and request any present or former employer, state/federal government office, state department of

motor vehicles, credit bureau, school, police department, court records, including those maintained by both public

and private organizations, financial institution or other persons having personal knowledge about me, to furnish A-

Check America, Inc. with any and all information in their possession regarding me for the purpose of confirming

the information contained on my Application and/or obtaining other information which may be material to my

qualifications for employment. I am willing that a photocopy of this authorization be accepted with the same

authority as the original, and I specifically waive the need to receive a written notice for disclosure of information

from any present or former employer who may provide information based upon this authorization.

I release all parties and persons from any and all liability for any damages that may result from furnishing such

information to Harbor Freight Tools as well as from the use or disclosure or such information by the company or

any of its agents, employees, or representatives.

The following is my true and complete legal name and all information is true and correct to the best of my

knowledge:

Print Full Name: _ ______

Print Maiden Name or Other Names Used:

Present Address:

City: _______ State: Zip Code:

Date of Birth (for I.D. purposes only): __ / ___/___ ___ (MM/DD/YYYY)

Social Security Number: _________-______ - ___________

Driver’s License Number: State of Issuance:

A-Check America will need to contact you if additional information is needed to process your Background

Investigation. Please provide a cell and/or alternate phone number and email address where we may contact you.

Cell Phone: ( ) - Alternate Phone: ( ) _____ _- _______ ____

Email Address: ___________________________________________________________________

Signature: _______________________________________ Date: _________________

(Please do not type in name; your hand-written signature is required above)

NOTICE: This form is the property of A-Check America, Inc. No alterations to its content may be made without the prior written consent of its author. Any changes

made without A-Check’s authorization are considered a breach of contract.

California, Minnesota and Oklahoma Residents Only:

If a consumer background report is ordered, would you like a free copy of the report mailed to your home?

YES

□

Signature: Date: ______/_____/_______

IMPORTANT NOTICE TO APPLICANT

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) is designed to

promote accuracy, fairness, and privacy of information if the

files of every "consumer reporting agency" (CRA). Most

CRA's are credit bureaus that gather and sell information about

you - such as if you pay your bills on time or have filed bank-

ruptcy - to creditors, employers, landlords, and other busi-

nesses. You can find the complete text of the FCRA, 15 U.S.C.

1681-1681u, at the Federal Trade Commission's web site

(http://www.ftc.gov). The FCRA gives you specific rights,

as outlined below. You may have additional rights under state

law. You may contact a state or local consumer protection

agency or a state attorney general to learn those rights.

• You must be told if information in your file has been used

against you. Anyone who uses information from a CRA to

take action against you - such as denying an application for

credit, insurance, or employment - must tell you, and give

you the name, address, and phone number of the CRA that

provided the consumer report.

• You can find out what is in your file. At your request, a

CRA must give you the information in your file, and a list of

everyone who has requested it recently. There is no charge

for the report if a person has taken action against you be-

cause of information supplied by the CRA, if you request the

report within 60 days of receiving notice of the action you

also are entitled to one free report every twelve months upon

request if you certify that (1) you are unemployed and plan

to seek employment within 60 days, (2) you are on welfare,

or (3) your report is inaccurate due to fraud. Otherwise, a

CRA may charge you up to eight dollars.

• You can dispute inaccurate information with the CRA. If

you tell a CRA that your file contains inaccurate informa-

tion, the CRA must investigate the items (usually within 30

days) by presenting to its information source all relevant evi-

dence you submit, unless your dispute is frivolous. The source

must review your evidence and report its findings to the CRA.

(The source also must advise national CRA's - to which it

has provided the data - of any error). The CRA must give you

a written report of the investigation results in any change. If

the CRA's investigation does not resolve the dispute, you may

add a brief statement to your file. The CRA must normally

include a summary of your statement in future reports. If an

item is deleted or a dispute statement is filed, you may ask

that anyone who has recently received your report be noti-

fied of the change.

• Inaccurate information must be corrected or deleted. A CRA

must remove or correct inaccurate or unverified information

from its files, usually within 30 days after you dispute it. How-

ever, the CRA is not required to remove accurate data from

your file unless it is outdated (as described below) or cannot

be verified. If your dispute results in any change to your re-

port, the CRA cannot reinsert into your file a disputed item

unless the information source verifies its accuracy and com-

pleteness. In addition, the CRA must give you a written no-

tice telling you it has reinserted the item. The notice must

include the name, address and phone number of the informa-

tion source.

• You can dispute inaccurate items with the source of the

information. If you tell anyone - such as a creditor who re-

ports to a CRA - that you dispute an item, they may not then

report the information to a CRA without including a notice

of your dispute. In addition, once you've notified the source

of the error in writing, it may not continue to report the infor-

mation if it is, in fact, an error.

• Outdated information may not be reported. In most cases,

a CRA may not report negative information that is more than

seven years old; ten years for bankruptcies.

• Access to your file is limited. A CRA - may provide infor-

mation about you only to people with a need recognized by

the FCRA - usually to consider an application with a credi-

tor, insurer, employer, landlord, or other business.

• Your consent is required for reports that are provided to

employers, or reports that contain medical information. A

CRA may not give out information about you to your em-

ployer, or prospective employer, without your written con-

sent. A CRA may not report medical information about you

to creditors, insurers, or employers without your permission.

• You may choose to exclude your name from CRA lists for

unsolicited credit and insurance offers. Creditors and insur-

ers may use file information as the basis for sending you un-

solicited offers of credit or insurance. Such offers must in-

clude a toll-free phone number for you to call if you want

your name and address removed from future lists. If you call,

you must be kept off the lists for two years. If you request,

complete, and return the CRA form provided for this pur-

pose, you must be taken off the lists indefinitely.

• You may seek damages from violators. If a CRA, a user or

(in some cases) a provider of CRA data, violates the FCRA,

you may sue them in state or federal court.

The FCRA gives several different federal agencies authority to enforce the FCRA:

For Questions or Concerns Regarding:

CRAs, creditors and others not listed below

Please Contact:

Federal Trade Commission

Consumer Response Center - FCRA

Washington, DC 20580

202-326-3761

National banks, federal branches/agencies

of foreign banks (word "National" or

initials "N.A." appear in or after bank's

name)

Office of the Controller of the

Currency/Compliance Management

Mail Stop 6-6

Washington, DC 20219

800-613-6743

Federal Reserve System member banks

(except national banks, and federal

branches/agencies of foreign banks)

Federal Reserve Board

Consumer and Community Affairs

Washington, DC 20551

202-452-3693

Savings associations and federally

chartered savings banks (word "Federal"

or initials "F.S.B." appear in federal

institution's name)

Office of Thrift Supervision

Consumer Programs

Washington, DC 20552

800-842-6929

Federal credit unions (words "Federal

Credit Union" appear in institution's

name)

National Credit Union Admin.

1775 Duke Street

Alexandria, VA 22314

703-518-6360

State-chartered banks that are not

members of the Federal Reserve System

Federal Deposit Insurance Corp.

Division of Compliance &

Consumer Affairs

Washington, DC 20429

800-934-FDIC

Air, surface, or rail common carriers

regulated by former Civil Aeronautics

Board or Interstate Commerce Commission

Department of Transportation

Office of Financial Management

Washington, DC 20590

202-366-1306

Activities subject to the Packers and

Stockyards Act, 1921

Department of Agriculture

Office of Deputy Administrator -

GIPSA

Washington, DC 20250

202-720-7051

21719

NOTICE TO USERS OF CONSUMER REPORTS:

OBLIGATIONS OF USERS UNDER THE FCRA

The federal Fair Credit Reporting Act (FCRA) requires that

this notice be provided to inform users of consumer reports

of their legal obligations. State law may impose additional

requirements. The first section of this summary sets forth the

responsibilities imposed by the FCRA on all users of con-

sumer reports. The subsequent sections discuss the duties of

users of reports that contain specific types of information, or

that are used for certain purposes, and the legal consequences

of violations. The FCRA, 15 U.S.C. 1681-1681u, is set forth

in full at the Federal Trade Commission's Internet web site

(http://www.ftc.gov).

I. OBLIGATIONS OF ALL USERS OF CONSUMER

REPORTS

A. Users Must Have a Permissible Purpose

Congress has limited the use of consumer reports to protect

consumer's privacy. All users must have a permissible pur-

pose under the FCRA to obtain a consumer report. Section

604 of the FCRA contains a list of the permissible purposes

under the law.

These are:

• As ordered by a court or a federal grand jury subpoena.

Section 604(a)(1)

• As instructed by the consumer in writing.

Section 604(a)(2)

• For the extension of credit as a result of an application

from a consumer, or the review or collection of a consumer's

account. Section 604(a)(3)(A)

• For employment purposes, including hiring and

promotion decisions, where the consumer has given

written permission. Sections 604(a)(3)(B) and 604(b)

• For the underwriting of insurance as a result of an

application from a consumer. Section 604(a)(3)(C)

• When there is a legitimate business need, in connection

with a business transaction that is initiated by the consumer.

Section 604(a)(3)(F)(i)

• To review a consumer's account to determine whether

the consumer continues to meet the terms of the account.

Section 604(a)(3)(F)(ii)

• To determine a consumer's eligibility for a license or other

benefit granted by a governmental instrumentality required

by law to consider an applicant's financial responsibility

or status. Section 604(a)(3)(D)

• For use by a potential investor or servicer, or current

insurer, in a valuation or assessment of the credit or

prepayment risks associated with an existing credit

obligation. Section 604(a)(3)(E)

• For use by state and local officials in connection with the

determination of child support payments, or modifications

and enforcement thereof. Sections 604(a)(4) and 604(a)(5)

In addition, creditors and insurers may obtain certain con-

sumer report information for the purpose of making unsolic-

ited offers of credit or insurance. The particular obligations

of users of this "prescreened" information are described in

Section V below.

B. Users Must Provide Certifications

Section 604(f) of the FCRA prohibits any person from ob-

taining a consumer report from a consumer reporting agency

(CRA) unless the person has certified to the CRA (by a gen-

eral or specific certification, as appropriate) the permissible

purpose(s) for which the report is being obtained and certi-

fies that the report will not be used for any other purpose.

C.Users Must Notify Consumers When Adverse Actions Are

Taken

The term "adverse action" is defined very broadly by Section

603 of the FCRA. "Adverse actions" include all business,

credit, and employment actions affecting consumers that can

be considered to have a negative impact - such as unfavor-

ably changing credit or contract terms or conditions, denying

or canceling, credit or insurance, offering credit on less fa-

vorable terms than requested, or denying employment or pro-

motion.

1. Adverse Actions Based on Information Obtained From a

CRA.

If a user takes any type of adverse action that is based at least

in part on information contained in a consumer report, the

user is required by Section 615(a) of the FCRA to notify the

consumer. The notification may be done in writing, orally, or

by electronic means. It must include the following:

• The name, address, and telephone number of the CRA

(including a toll-free telephone number, if it is a

nationwide CRA) that provided the report.

• A statement that the CRA did not make the adverse

decision and is not able to explain why the

decision was made.

• A statement setting forth the consumer's right to obtain a

free disclosure of the consumer's file from the CRA if the

consumer requests the report within 60 days.

• A statement setting forth the consumer's right to dispute

directly with the CRA the accuracy or completeness of any

information provided by the CRA.

2. Adverse Actions Based on Information Obtained

From Third Parties Who Are Not

Consumer Reporting Agencies:

If a person denies (or increases the charge for) credit for per-

sonal, family, or household purposes based either wholly or

partly upon information from a person other than a CRA,

and the information is the type of consumer information cov-

ered by the FCRA, Section 615(b)(1) of the FCRA requires

that the user clearly and accurately disclose to the consumer

his or her right to obtain disclosure of the nature of the infor-

mation that was relied upon by making a written request within

60 days of notification. The user must provide the disclosure

within a reasonable period of time following the consumer's

written request.

3. Adverse Actions Based on Information

Obtained From Affiliates:

If a person takes an adverse action involving insurance, em-

ployment, or a credit transaction initiated by the consumer,

based on information of the type covered by the FCRA, and

this information was obtained from an entity affiliated with

the user of the information by common ownership or control,

Section 615(b)(2) requires the user to notify the consumer of

the adverse action. The notification must inform the consumer

that he or she may obtain a disclosure of the nature of the

information relied upon by making a written request within

60 days of receiving the adverse action notice. If the con-

sumer makes such a request, the user must disclose the na-

ture of the information not later than 30 days after receiving

the request. (Information that is obtained directly from an

affiliated entity relating solely to its transactions or experi-

ences with the consumer, and information from a consumer

report obtained from an affiliate are not covered by Sction

615(b)(2).)

APPLICANT: Please read and keep this document.

Applicant Survey

Work Opportunity Tax Credit Program

Harbor Freight Tools is participating in the Work Opportunity Tax Credit program. This

program is designed by the federal government to help companies hire more people into the

workforce and to retain employees through federal incentives.

Your response to the questions below will help us determine if Harbor Freight Tools qualifies

for this program. Any information you provide will be kept confidential and will not affect your

job, wages, or taxes. Thank you in advance for your time and participation.

 Check here if any of the following statements apply to you:

• I am a member of a family that has received Temporary Assistance for Needy Families (TANF) for any of the

following:

z During the last four years

z Stopped being eligible for TANF within the last two years because of limitations on how long the benefit

. could be received

• I was referred here by a rehabilitation agency approved by the state or the Department of Veteran Affairs.

• I am 18-39 years of age and I am a member of a family that received food stamps within the last two years.

• I received Supplemental Security Income (SSI) beneﬁts within the last two months.

• Within the past year, I was convicted of a felony or released from prison for a felony.

• I am a veteran and either:

z A member of a family that received food stamps within the last two years

z Entitled to compensation for a service-connected disability

 Check here if none of the statements above apply to you. (N/A)

Name __________________________________________________________ Date ____________________________

Please keep this form in your store emplo yee file. For warehouse or corporate locations, please sen d this form to Human Resources.