Luke's Super Liquors Job Application

Basic Information

Full Name (Last, First, Middle) *
Please provide us with your FULL LEGAL NAME, formatted LAST, FIRST, MIDDLE, i.e. if your name is Charles F. Smith, format your name as "Smith, Charles F."
Home Phone # *
Cell Phone # *

Social Security Number

If you are called by Luke's management, we will inquire about Social Security Number info. Luke's management WILL NEVER request that you provide your Social Security Number online.
Have You Ever Worked for a Luke's Super Liquors store in the Past? *
 Yes 
 No 
If you HAVE worked for a Luke's Super Liquors store in the past, for which location did you work?
Briefly Describe the Time Period During Which You Worked for Luke's (i.e. did you work from March of 1999 - June of 2003, etc)
Are You 21 or Older?
 Yes 
 No 
Are You 18 or Older?

If Not, Please Provide Your Date of Birth in the Next Spot *
 Yes 
 No 
If You're Under 18, Please Provide Your Date of Birth Here
Are You Eligible for Employment in the United States of America? *
 Yes 
 No 
For the desired position, would a supervisory relationship or conflict of interest exist with any relative who is currently employed by Luke's? *
 No 
 Yes (provide employee name in next box) 
Conflicting Employee's Name (if applicable)
How Did You Learn of Our Employment Opportunities?
 Newspaper Ad 
 Employee Referral 
 Walk-In 
 Other 

Position Desired

Please Describe the Position You Desire, Pay Expected, etc.
Position Desired *
Pay Expected
Enter the pay you would expect. If you're looking for part-time work, enter the $ / hour that you would expect, or if you are looking for salary/full-time employment, please enter your expected annual salary.
Location Desired
What Date Can You Begin Work? *

MM		/
DD		/
YYYY
Please enter the soonest date you would be able to begin working, or put today's date if you can begin immediately.
How Many Hours Would You Be Able to Work Per Week? *
 3-15 hrs 
 16-25 hrs 
 26-30 hrs 
 40 hrs full-time / salary 
Please Check All of the Times You Would Be Able to Work for the Following Days (hours are rough approximations of our shifts) *
 Weekday Mornings 
 Weekday Evenings 
 Weekend Mornings 
 Weekend Evenings 
 Holidays 
Specific Scheduling Conflicts Which May Arise:
If Your Preferred Schedule is Not Available, Would You Be Open to an Alternative Schedule? *
 Yes 
 No 
Are You Able to lift up to fifty (50) pounds frequently in a shift? *
 Yes 
 No 
Special Skills / Training
Please breifly describe any special skills / training, degrees, certifications, or abilities you feel might be an asset to Luke's

Education

Please Check the Box Which Most Accurately Describes Your Education Level
 High School Graduate 
 College Graduate 
 Some College 
 Some High School 

High School
High School Name
Courses of Study
# of Years Completed
Did You Graduate?
 Yes 
 No 

College
College / University Name
Courses of Study
# of Years Completed
Did You Graduate?
 Yes 
 No 
Type of Degree
 Bachelor's 
 Master's 
 Doctorate 
 Did Not Graduate 

Employment History

Please Provide Information for All Jobs Worked in the Past Five (5) Years.

Job # 1
Company Name
Company Telephone #
Company Address
Direct Supervisor's Name / Title
Start Date (roughly)

MM		/
DD		/
YYYY
End Date (roughly)

MM		/
DD		/
YYYY
Starting Pay (per hour)
Ending Pay (per hour)
Jobs & Responsibilities
Reason For Leaving (be specific)
May We Contact?
 Yes 
 No (explain) 
If we may NOT contact your former employer, please explain why:
Reason(s) for requesting that Luke's may NOT contact your former employer

Job # 2
Company Name
Company Telephone #
Company Address
Direct Supervisor's Name / Title
Start Date (roughly)

MM		/
DD		/
YYYY
End Date (roughly)

MM		/
DD		/
YYYY
Starting Pay (per hour)
Ending Pay (per hour)
Jobs & Responsibilities
Reason For Leaving (be specific)
May We Contact?
 Yes 
 No (explain) 
If we may NOT contact your former employer, please explain why:
Reason(s) for requesting that Luke's may NOT contact your former employer

Job # 3
Company Name
Company Telephone #
Company Address
Direct Supervisor's Name / Title
Start Date (roughly)

MM		/
DD		/
YYYY
End Date (roughly)

MM		/
DD		/
YYYY
Starting Pay (per hour)
Ending Pay (per hour)
Jobs & Responsibilities
Reason For Leaving (be specific)
May We Contact?
 Yes 
 No (explain) 
If we may NOT contact your former employer, please explain why:
Reason(s) for requesting that Luke's may NOT contact your former employer

Personal References

Please list two (2) references (other than immediate family/household members, significant others, or close personal friends)

Reference # 1
Full Name
Daytime Phone Number
Evening Phone Number
Explain Relationship:

Reference # 2
Full Name
Daytime Phone Number
Evening Phone Number
Explain Relationship:

Authorization

By clicking "Submit Form", you hereby declare that:

The information provided by me in this application is true, correct and complete to the best of my knowledge. I understand that if employed, any falsification, misstatement, or omission of fact in connection with my application, whether on this document or not, may result in immediate termination of my employment.

I authorize you to verify any and all information listed above, including personal references, employment history, and educational history. I release all parties from all liability from any result from furninshing the requested information to you.

I acknowledge that, at any time during my employment, I may be subject to incident-based substance abuse testing.

I acknowledge that if I become employed, I will be employed at will, which means that I will be free to terminate my employment ant any time for any reason, and Luke's Super Liquors is free to terminate my employment at any time for any reason except as prohbited by law.

No employee of Luke's Super Liquors has the authority to make any contrary agreement.
Attach a Resume
If You Have a Resume You Would Like Luke's Super Liquors management to look at, please attach it here. Your resume must either be in PDF, DOC, DOCX, or TXT format.