Application For Employment
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Personal Information
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| Name
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| Home Telephone
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| Mobile Telephone
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Work
Telephone
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| Email
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| Social Security Number
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| Are you at least 18 years of age?
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Yes No
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| Are you eligible to work in the United States?
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Yes No
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| Have you been convicted of any crime other than a minor traffic offense within the last five years?
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Yes No
If yes, answer in the space below to the nature of crime, when, where, and disposition of case (conviction of a crime is not an automatic bar to employment).
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POSITION/AVAILABILITY:
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| Position Applied For
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| Store Location Applying For:
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| Salary / Wage per hour expected?
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| Days Available
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Monday Tuesday Wednesday Thursday Friday Saturday Sunday Any
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| Hours Available
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AM PM For specific Day/Hour availability, please enter information below.
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| What date are you available to start work?
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| How were you referred to this organization?
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| Do you have any friends or relatives in our employ?
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Yes No If yes, give details.
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| Name of Employee
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| Relationship
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| Have you ever worked for this organization before?
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Yes No If yes answer below with the date and position.
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| Date
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| Position
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This application is current only for thirty (30) days, at the conclusion of which time, if you have not heard from us and still wish to be considered for employment, it will be necessary for you to fill out a new application.
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EDUCATION:
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| Name and Address Of School - Degree/Diploma - Graduation Date
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MILITARY SERVICE
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| Branch of Service - From - To
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| Rank at Time of Discharge
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| Description of Duties While in Service
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| Skills and Qualifications: Licenses, Skills, Training, Awards
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EMPLOYMENT HISTORY:
Present Or Last Position:
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| Employer:
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| Address:
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| Supervisor:
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| Phone Number
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| Email
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| Position Title:
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| Start Date
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| End Date
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| Responsibilities:
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| Salary
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Input hourly wage, if not salaried.
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| Reason for Leaving:
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| May We Contact Your Present Employer?
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Yes No
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Previous Position
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| Employer:
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| Supervisor:
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| Phone Number
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| Email
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| Position Title:
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| Start Date
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| End Date
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| Responsibilities:
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| Salary
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Input hourly wage, if not salaried.
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| Reason for Leaving:
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References:
Name/Title Address Phone
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HEALTH INFORMATION
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| Do you have any physical or mental impairments that would interfere with your ability to do moderate to heavy lifting, moderate climbing, operate equipment, or move around the store on a frequent basis?
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Yes No
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| If yes, please explain:
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DRUGS IN THE WORK PLACE
We reserve the right to ask applicant to submit to a drug test before employment and/or a random drug test anytime during the duration of your employment.
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| In Case of Emergency, Notify:
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| Phone Number
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| Alternate Phone Number
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CERTIFICATION
I certify that information contained in this application is correct to the best of my knowledge and understand that falsification or misrepresentation is grounds for dismissal in accordance with the COMPANY policy.
I authorize the references listed in this application to give you any and all information that they may have, and release all parties from all liability for any damage that may result from furnishing same to to you.
In consideration of my employment, I agree to confirm to the rules and regulations of the Company and my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the Company or myself and without notice or liability for wages or salary except such earned at the date of such termination. I understand that no manager, supervisor or representative of management, specified period of time, or to make any agreement contrary to the foregoing.
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| Do you agree with the terms and conditions?
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Yes, I agree.
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| Initial
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| Date
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Image Verification
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EMF Contact Form