APPLICATION FOR EMPLOYMENT

AN EQUAL OPPORTUNITY EMPLOYER

Fields marked with * are mandatory

POSITION DESIRED

DATE AVAILABLE

TODAYS DATE:

FIRST NAME

MIDDLE NAME

LAST NAME

ADDRESS

CITY

STATE

ZIP CODE

E-MAIL ADDRESS:

PHONE NUMBER:

DO YOU WISH TO WORK:

Full TimePart TimeSeasonal

Please indicate hours you are available to work:

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

EDUCATION

NAME AND LOCATION OF SCHOOL

NO. OF YEARS ATTENDED

MAJOR COURSE(S)

GRADUATED OR DEGREEYESNO

NAME AND LOCATION OF SCHOOL

NO. OF YEARS ATTENDED

MAJOR COURSE(S)

GRADUATED OR DEGREE

NAME AND LOCATION OF SCHOOL

NO. OF YEARS ATTENDED

MAJOR COURSE(S)

GRADUATED OR DEGREE

NAME AND LOCATION OF SCHOOL

NO. OF YEARS ATTENDED

MAJOR COURSE(S)

GRADUATED OR DEGREE

SKILLS

POS MACHINEKEY CUTTING MACHINEPAINT MIXING MACHINEWORD PROCESSINGELECTRICALPLUMBINGBUILDING CONSTRUCTIONPERSONAL COMPUTER

EMPLOYMENT HISTORY

Give Names and Addresses of All Previous Employers. If you are now working, present employer and reason for desire to quit must be included. Additional paper will be provided upon request. Also give reason for any lapse of time between jobs. MAY WE CONTACT YOUR CURRENT EMPLOYER?:

YESNO

EMPLOYER(Latest First)


NAME:

ADDRESS/CITY/STATE/ZIP:

TELEPHONE:

SUPERVISOR:

DATES EMPLOYED

FROM:

TO:

EARNINGS HISTORY

START

FINAL

TITLES AND DUTIES:

REASON FOR LEAVING:


NAME:

ADDRESS/CITY/STATE/ZIP:

TELEPHONE:

SUPERVISOR:

DATES EMPLOYED

FROM:

TO:

EARNINGS HISTORY

START

FINAL

TITLES AND DUTIES:

REASON FOR LEAVING:


NAME:

ADDRESS/CITY/STATE/ZIP:

TELEPHONE:

SUPERVISOR:

DATES EMPLOYED

FROM:

TO:

EARNINGS HISTORY

START

FINAL

TITLES AND DUTIES:

REASON FOR LEAVING:


NAME:

ADDRESS/CITY/STATE/ZIP:

TELEPHONE:

SUPERVISOR:

DATES EMPLOYED

FROM:

TO:

EARNINGS HISTORY

START

FINAL

TITLES AND DUTIES:

REASON FOR LEAVING:

MILITARY SERVICE

FINAL RANK/GRADE

BRANCH

SPECIALTY/MOS

RESERVE STATUS

Have you ever been employed by our Company?

YESNO

IF YES, WHEN

WHERE

Do you have any relatives employed by our Company?

YESNO

If yes, please state person’s name, job and employment location

GENERAL INFORMATION

Have you ever been convicted or pleaded guilty to a felony?

YESNO

If yes, give full details. (Conviction won’t necessarily disqualify you for the position for which you are applying.)

If hired, can you furnish proof of age?

YESNO

If, hired, can you furnish proof you are legally entitled to work in U.S.?

YESNO

How did you hear of our Company?

Employee ReferralOwn AccordAdvertisingAgencyOther

If Employee Referral:

If Agency:

If Other, please specify:

Are there any other experiences, skills, or qualifications which you feel would especially fit you for work with the Company?

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING BELOW:

This application is considered current for 90 days. If you want to be considered for employment after this time you must renew your application in writing.

Store Hours

Monday - Saturday
8:00am - 7:00pm

Sunday
1:30pm - 6:00pm

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CONTACT: Have questions or comments? Send us an email or call (864) 225-1406