Personal Information
Please print. You must fully and accurately complete this application. Incomplete applications will not
be considered.
Position(s) applying for:_________________________________________
Date of application:____________________
Name:______________________________________________________
Phone:(_____)_______________________
Address:___________________________________________________________________________________
Are you 16 or older? ___Yes ___No Are you 18 or older? ___Yes ___No
List outside activities (please do not list activities that would reflect race, color, religon, sex, national
origin, disability, or ancestry.):
_____________________________________________________________________________________
Work Availability
Type of employment desired: ___ Full Time ___ Part-time
Number of hours available per week:_____________
Do you have any commitments to another employer that might affect your employment with us? ___ Yes ___ No
Are you legally eligible for employment in this country ( a citizen or alien authorized to work in the United States)?
___ Yes ___ No |
To help us consider a job that matches
your availability, please specify the
days/hours you would be able to work
each day (i.e., 8:00 am to 5:00 pm, 3:00
pm to 7:00 pm):
Monday _________________________
Tuesday ________________________
Wednesday ______________________
Thursday _______________________
Friday _________________________
Saturday _______________________
Sunday _________________________ |
General Information
Have you ever worked for this company before? ___ Yes ___ No
If yes, give dates employed: ______________________
Are any of your relatives employed by this company? ___ Yes ___ No
If yes, please list name(s), relationship and store location:
Name:________________________ Relationship:________________________ Location:_________________________________________________
Have you ever been convicted of a crime, excluding misdemeanors and traffic violations?
___ Yes ___ No
If yes, describe in full:____________________________________________________
_______________________________________________________________________________________________
(The existence of a criminal record will not automatically disqualify you from the job you applied for.)
Educational History
Circle the last grade you completed in high school: 8 or less 9 10 11 12 GED
Your average grades?:_____________
Name and location of school: ______________________________________________________________
Circle last year of college, tech or business school: 1 2 3 4 Did you graduate? ___ Yes ___ No
Your average grades?:______________
Your major course of study?:_____________________________________
Name and location of school:
______________________________________________________________________
What school activities and organizations including athletics did you participate in?: (Please do not list
those activities that would reflect race, color, religon, sex, national origin. disability or ancestry.)
_______________________________________
___________________________________________________________________________________________
What scholastic honors did you receive?: __________________________________________________________
Work History
GIVE PRESENT OR MOST RECENT POSITION FIRST. Information must be complete and accurate.
Can we contact your current employer?: ___ Yes ___ No
Company Name:______________________
Address: __________________________________________
Phone #:(____) ___________________
Supervisor's name and title: ___________________________________
Employment dates: From:__________________ To: __________________
Rate of pay* : _______________
Position held:___________________________________________________________
Major responsibilities: __________________________________________________________________
Reason for leaving: ______________________________________________________________________
Company Name:______________________
Address: __________________________________________
Phone #:(____) ___________________
Supervisor's name and title: ___________________________________
Employment dates: From:__________________ To: __________________
Rate of pay* : _______________
Position held:_______________________________________________________________
Major responsibilities: __________________________________________________________________
Reason for leaving: _____________________________________________________________________
Company Name:______________________
Address: __________________________________________
Phone #:(____) ___________________
Supervisor's name and title: ___________________________________
Employment dates: From:__________________ To: __________________
Rate of pay* : _______________
Position held:_____________________________________________________________
Major responsibilities: __________________________________________________________________
Reason for leaving: _____________________________________________________________________
*Applicant need not answer rate of pay.
Have you ever been disciplined for absenteeism or tardiness?: ___ Yes ___ No
What other special qualifications do you have not listed above?:______________________________________________________________________
Breifly state why you would like to work with our company: _______________________________________________________________________________
US Military Service
Branch of service: _____________________________________
From: ____________ To: _______________
Describe any special training: ______________________________________________________________
Important, please read carefully
I understand that to be employed I must be lawfully authorized to work in the United States and able to show the employer documents to prove this.
I understand that the company will thoroughly investigate my work and personal history and verify all given data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therin, except my current employer if noted, to provide any information requested about me, and I release them from all liability for damage in providing this information. I authorize the company to secure records regarding my criminal conviction history from the appropriate law enforcement agencies.
All of the information on this application and made in conjuction with this application is correct and true to the best of my knowledge. I understand that any false or misleading statement made by me in connection with this application or the failure to disclose any material information will be grounds for immediate dismissal. I understand that if hired I will have a probationary period durng which time I may be terminated at the discretion of the compaany. Thereafter, the terms of my continued employment will be pursuant to the written employment policies that the company may from time to time determine.Signature: _________________________________ Date: __________________
Apllications become inactive after 90 days. If you wish to be considered after that time, you must complete a new application.JC 3/98