Employment Application

Personal Information

First Name:

Middle Name:

Last Name:

Email Address:

Street Address:

City:

State:

Zip:

Home Number:

Business Number:

May we contact at work?:

May we contact at work?:

Yes No

Position Applying For:

Date Available:

Interested In (check all that apply):

Interested In:

Full Time Part-Time Temporary Summer

Hours of Availability (Example 5pm-9pm, or leave fields blank if they do not apply)

Hours for Monday:

Hours for Tuesday:

Hours for Wednesday:

Hours for Thursday:

Hours for Friday:

Hours for Saturday:

Hours for Sunday:

Willing to reloctate?:

Willing to reloctate?:

Yes No

If under 18 years of age, date of birth:

Willing to travel?:

Willing to travel?:

Yes No

Legal

Are you a U.S. citizen?:

Are you a U.S. citizen?:

Yes No

If no, do you have legal right & necessary documents to work in the U.S.?:

If no, do you have legal right & necessary documents to work in the U.S.?:

Yes No

(Identity and employment eligibility of all new hires will be verified as required by the Immigration Reform and Control Act of 1986.)

Were you ever discharged by any company?:

Were you ever discharged by any company?:

Yes No

If yes, give name of company(ies):

Have you ever been convicted of a crime other than a minor traffic violation?:

Have you ever been convicted of a crime other than a minor traffic violation?:

Yes No

Please Read Carefully

In submitting this application for employment, I understand that an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, educational background, and/or criminal history. I authorize anyone possessing this information to furnish it to this company and/or a 3rd party company upon request and I release anyone so authorized, this company, and any 3rd party company form all liability and damages whatsoever in furnishing, obtaining or using said information.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate termination. I understand also that I am required to abide by all rules and regulations of this company.

I understand and agree that if employed, the employment will be “at will.” That is, either this company or I may end the employment relationship at any time, for any reason, or for no reason. I understand that receipt of this application by this company does not imply employment and that this application and/or any other company documents are not contracts of employment.

I understand that I must be physically capable of performing the essential job functions, with or without reasonable accommodation, described therein.

*Please note that you may still be required to fill out more information regurding Employment History and/or Education before or after being interviewed.

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