Job Application Application For Employment PLEASE FILL IN ALL REQUESTED INFORMATION Employment Application PERSONAL INFORMATION First Name * Middle Name Last Name * Present Address * Present Address Present Address Present Address Present Address Present Address State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Present Address Phone * Other Phone Email Referred by Position Applied For Date available Type of employment desired Full-Time Part-Time Temporary Seasonal Educational Co-Op Salary desired Date of Birth Are you legally eligible for employment in this country? Yes No Languages English OtherOther Are you available to work overtime if required? Yes No Are you available to work weekends if required? Yes No Have you been employed at this company before? Yes No If "Yes": when and what location? As part of our company policy, it is standard procedure to perform a criminal background check on someone we are considering for employment. Would you object to such a procedure? Yes No EDUCATIONAL BACKGROUND List previous three (3) educational institutions attended, beginning with the most recent. School #1 Select School Type #1 High School College Bus. or Trade School Professional School Graduated? Yes No School #2 Select School Type #1 High School College Bus. or Trade School Professional School Graduated? Yes No School #3 Select School Type #3 High School College Bus. or Trade School Professional School Graduated? Yes No EMPLOYMENT BACKGROUND Provide the following information beginning with the most recent employer. EMPLOYER #1 Employer Name Address Phone Your Last Job Title Immediate Supervisor & Title Employment Dates Hourly Rate/Salary Reason for Leaving Summarize the type of work performed and job responsibilities May we contact for reference? Yes No Later EMPLOYER #2 Employer Name Address Phone Your Last Job Title Immediate Supervisor & Title Employment Dates Hourly Rate/Salary Reason for Leaving Summarize the type of work performed and job responsibilities May we contact for reference? Yes No Later EMPLOYER #3 Employer Name Address Phone Your Last Job Title Immediate Supervisor & Title Employment Dates Hourly Rate/Salary Reason for Leaving Summarize the type of work performed and job responsibilities May we contact for reference? Yes No Later EMPLOYER #4 Employer Name Address Phone Your Last Job Title Immediate Supervisor & Title Employment Dates Hourly Rate/Salary Reason for Leaving Summarize the type of work performed and job responsibilities May we contact for reference? Yes No Later COMMENTS: Including explanatin of any gaps in employment. PLEASE ANSWER THE FOLLOWING QUESTIONS What was the best job you’ve ever had? Why did you like it so much? What was your least favorite job? What did you NOT like about it? Who was the best supervisor or manager you’ve had? What characteristics made that person a good manager? Think of the WORST supervisor or manager you’ve had. What characteristics made that person a POOR manager? What are your greatest strengths? As your skills and abilities relate to your work experiences for this position, what are the areas for improvement? What traits or characteristics do you most admire in co-workers? What traits or characteristics do you most DISLIKE in co-workers? If you won five million dollars in the lottery, would you choose to work? What would you do with your time? What was the funniest thing that ever happened to you at work? What do you think is the most difficult part of this role? Imagine you have been on your feet and working hard all day. A customer you are assisting is rude and impatient, what do you do? REFERENCES List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please). Reference #1 Name Relationship Years Acquainted Phone Reference #2 Name Relationship Years Acquainted Phone Reference #2 Name Relationship Years Acquainted Phone I certify that all the information I have provided is true, complete and correct. I authorize you and your organization to investigate all statements contained on this application. I understand that any misrepresentation or omission of facts called for is cause for immediate disqualification and/or if employed, immediate dismissal. Furthermore, I understand and agree that if employed, I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same rights to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not in any way constitute an agreement or contract for employment. I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States of America. Applicant's Signature Date If you are human, leave this field blank. SUBMIT FORM