EMPLOYMENT APPLICATION

PLEASE COMPLETE BOTH PAGES

NAME: (LAST) (FIRST) (MIDDLE) SOCIAL SECURITY #

HOME ADDRESS CITY STATE ZIP CODE HOME PHONE

PERSON TO NOTIFY IN EMERGENCY: PHONE:

POSITION APPLIED FOR: DATE AVAILABLE:

ARE YOU 18 OR OLDER? IF NOT, STATE YOUR AGE DAYS/HRS AVAILABLE:

MUST BE ABLE TO PROVIDE AGE SUN

OR EMPLOYMENT CERTIFICATE MON

TUES

EDUCATION: NAME OF SCHOOL DID YOU GRADUATE? WED

THURS

HIGH SCHOOL: FRI

SAT

COLLEGE:

U.S. MILITARY SERVICE: BRANCH DATES OF SERVICE RANK

REFERENCES: PERSONAL (DO NOT LIST RELATIVES)

NAME: PHONE: YEARS KNOWN

EMPLOYMENT HISTORY: MAY WE CONTACT YOUR PRESENT EMPLOYER?

MAY WE CONTACT YOUR PRIOR EMPLOYERS?

EMPLOYER’S NAME/ADDRESS/PHONE DATES EMPLOYED POSITION HELD

FROM – TO SUPERVISOR

REASON FOR LEAVING

HAVE YOU EVER BEEN DISCHARGED BY ANY COMPANY?

WHY?

HAVE YOU, IN THE PAST 5 YEARS, BEEN CONVICTED OF A FELONY?

EXPLAIN

IT IS UNDERSTOOD THAT ANY FALSE STATEMENT IN THIS APPLICATION IS SUFFICIENT CAUSE FOR DISMISSAL.

APPLICANT’S SIGNATURE DATE SIGNED

PLEASE RETURN THIS APPLICATION TO OUR STORE IN PERSON.