Application For Employment
Please Fill Out Completely And Click Submit At The Bottom Of Page
Date
First Name
Last Name
Middle
Street Address
City
State
Zip
Phone
Are you a U.S. citizen or authorized to work in the U.S. on an unrestricted basis?
Are you at least 16 years old?
Are you at least 18 years old?
Are you looking for full-time employment?
Are you looking for part-time work?.
Which shifts are you available to work?
Early Morning
Day Shift
.Evening Shift
All Shifts
Check which days you are available
Have you been convicted of a misdemeanor in the last five years?
Have you ever been convicted of a felony?
(This may not affect your application)
If yes to either of the above, please give details and dates.
Position applying for?
Store location?
Have you ever applied to us before?
When?
Where?
Are you currently employed?
May we contact your present employer?
Have you ever been employed by this company?
When?
Where?
Education School Name & Location Years Degree
High School
College
Employment History
Company Name
Address
Date Started
Date Ended
Name of Supervisor
Telephone
Starting Position
Ending Postion
May we contact?
Starting Wage
Ending Wage
Responsibilities
Reason for leaving?
Company Name
Address
Telephone
Date Started
Starting Wage
Date Ended
Ending Wage
Starting Position
Ending Postion
Name of Supervisor
May we contact?
Responsibilities
Reason for leaving?
In addition to your work history, are there are other skills or experience that we should consider?
References
List 2 references, not related to you, that you’ve known more than one year (Business or Personal)
Name Phone Years known
Emergency Contact Relationship Telephone
Name Phone Years known
Emergency Contact Relationship Telephone
Please Read Before Submitting.
I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.
I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application.
I understand that this company will do a background check before offering a position with their company. My signature below means that I understand and authorize said background check. (I understand that this is the FINAL step in the application process and will only be done if I am being seriously considered for a position.)
