Employment Information
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:
Last
First
Middle
Address:
Street
City
State
Zip
Are you 16 or older?
Are you 18 or older?
List outside activities (please do not list activities that would reflect race, color, religion, sex, national origin, disability or ancestry):
Have you ever worked for this company before?:
If yes, give dates employed:
Are any of your relatives employed by this company?
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?
If yes, describe in full:
(The existence of a criminal record will not automatically disqualify you from the job you applied for.)
Wage expected per hour:
If necessary, when would be the best time to call you at home?:
Work Availability
Type of employment desired:
Date available for work:
Number of hours available per week:
To help us consider a job that matches your availability, please specify the days and the time each day you would be available to work:
Do you have any commitments to another employer that might affect your employment with us?:
Are you legally eligible for employment in this country (a US citizen or alien authorized to work in the United States)?:
Educational History
Last grade completed in high school:
Your average grades?:
Name and location of school:
Last year of college, tech or business school:
Did you graduate?:
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 which would reflect race, color, religion, sex, national origin, disability or ancestry.)
What scholastic honors did you receive?:
US Military Service
Branch of Service:
From:
To:
Describe any special training:
Work History
GIVE PRESENT OR MOST RECENT POSITION FIRST. Information must be complete and accurate.
Can we contact your current employer?:
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:
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?:
What other qualifications do you have not listed above?:
Briefly state why you would like to work with our company:
IMPORTANT, PLEASE READ CAREFULLY.
We are an equal employment opportunity company. We are dedicated to a policy of non-discrimination in employment on any basis including race, creed, age, sex, religion, national origin, height, weight, marital status, or disability.

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 data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so 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 conjunction 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.

In consideration of my employment, I agree to conform to the rules and regulations of this company, and my employment and compensation can be terminated, with or without cause, and with or without notice, at any tme, at the option of either the company or myself. I understand that no manager or representative of this company, other than the president/owner of the company, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.
Initial:
Date:
Applications become inactive after 90 days. If you wish to be considered after that time, you must complete a new application.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Full
Part-Time
Yes
No
Yes
No
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8 or less
9
10
11
12
GED
1
2
3
4
Yes
No
Yes
No
Yes
No