Employment Opportunities

PERSONAL INFORMATION

Town or City You're Applying for*

Select the location(s) you would like to send your application.

Type of Employment*

Full Time

Part Time

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Age: Are you?*

14-15

16-17

18 or older

Email*

Enter Email Confirm Email

Phone*

Date available to start work*

Is your citizenship or immigration status such that you can lawfully work in the U.S.?*

Yes

Please indicate what days you are available and the hours in those days you are available*

EMPLOYMENT HISTORY

Company Name

Company Address

Street Address Address Line 2 City State ZIP Code

Company Phone

Supervisor Name

First Last

Your Position

Your Duties

Dates Employed

Reason for Leaving

Earnings (Starting/Ending)

EMPLOYMENT HISTORY 2

Company Name

Company Address

Street Address Address Line 2 City State ZIP Code

Company Phone

Supervisor Name

First Last

Your Position

Your Duties

Dates Employed

Reason for Leaving

Earnings (Starting/Ending)

EDUCATION

High School*

College*

REFERENCES

Reference 1 Name*

First Last

Reference 1 - Occupation*

Reference 1 - Years Known*

Reference 1 - Phone*

Reference 2

Reference 2 - Name*

First Last

Reference 2 - Occupation*

Reference 2 - Years Known*

Reference 2 - Phone*

Reference 3

Reference 3 - Name

First Last

Reference 3 - Occupation*

Reference 3 - Years Known

Reference 3 - Phone*

OTHER

Have you ever been convicted of a crime (other than minor traffic violations)?*

Yes

If yes, please list all convictions, showing offense and date*

In your prior employment, have you had shortages or misunderstandings about merchandise or funds?*

Yes

If yes, please describe fully*

Have you ever been terminated from a job or asked to resign?*

Yes

If yes, please list dates and explain*

EMERGENCY INFORMATION

Emergency Contact's Name*

First Last

Emergency Phone*

Relationship*

Emergency Contact's Address*

Street Address Address Line 2 City State ZIP Code

This application will be given every consideration, but it's receipt does not imply that the applicant will be employed. "I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, either my or the company's options. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I give the employer the right to contact and obtain information from all references, employers' education institutions and to otherwise verify the accuracy of the information contained in this application."

I HAVE READ THE ABOVE STATEMENT AND AGREE*

I agree

PLEASE TYPE YOUR FULL NAME*

Comments

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