On-Line Employment Application
General Information:
First Name: Last Name: E-Mail:
Address: City: State: Zipcode:
Home Phone: Cell Phone: Are you at least 18 years of age? Yes No
Male Female When are you able to start? Hourly wage expected?
How were you referred? Walk In Job Fair Team Member Internet Other
When are you available to work? (If yes at what time i.e. 5pm to 9pm)
Monday: Yes No Tuesday: Yes No
Wednesday Yes No Thursday: Yes No
Friday: Yes No Saturday: Yes No
Sunday: Yes No Holidays: Yes No
Employment History:
Please list your last three employers, starting with your most recent.
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Employer's Name: Phone: Address:
Dates of Employment: (To and From) Job Title:
Supervisor: Duties: Starting Salary:
Ending Salary: Reason for Leaving:
Educational History:
Name and Location / Check Highest Grade Completed / Type of Degree or Certificate Received
High School: / 9th 10th 11th 12th /
Trade: / 1 2 3 4 /
College: / 1 2 3 4 /
Post Graduate: / 1 2 3 4 /
Other Skills:
Personal Interests:
Hobbies, Interests, or Special Skills (include speech or drama training):
Extra-Curricular Activities (scholastic or athletic):
Honors, Awards, or Leadership Positions Held:
Personal Data:
In accordance with the Immigration Reform Act of 1986, any offer of employment is conditioned upon satisfactory proof of applicant's identity and legal ability to work in the United States. Can you submit verification of your legal right to work in the United States? Yes No
Have you ever had a conviction of, plea of no contest to, plea of guilty to, or acceptance of any pre-trial diversion in lieu of charge of, any morals charge, felony or misdemeanor? Yes No
If yes, where and disposition:
I CERTIFY THAT ALL STATEMENTS GIVEN ON THIS APPLICATION ARE CORRECT. I REALIZE THAT FALSIFICATION OR MISREPRESENTATION, INCLUDING OMISSION, OF THIS OR ANY OTHER PERSONNEL RECORD MAY RESULT IN MY DISCHARGE REGARDLESS OF WHEN SUCH FALSIFICATION OR MISREPRESENTATION OR OMISSION IS DISCOVERED.
In the event of employment, I agree to abide by all present and subsequently issued rules of the company, and recognize that my employment is AT WILL and can be terminated at any time by myself or by the company with or without cause, other than for a reason which is prohibited by law. I understand that (except for a written employment agreement for a fixed term) no representative of the company has authority to enter into any agreement with me for a specified period of time, or that is not terminable AT WILL by myself or the company, or to make representations contrary to the foregoing.
Also, in the event of employment, and in consideration thereof, the Company and any person or concern it may authorize, shall be entitled, without further consent to copyright, sell or use in any manner, any picture or photograph of me (including still, video, or motion picture), or recording of my voice.
I HAVE CAREFULLY READ AND AGREED TO THE ABOVE AND HAVE ENTERED MY INITIALS AS AN ELECTRONIC SIGNATURE:
Please enter your initials in this box and then click on the submit button to finish your application.
(Please note: It may take a moment for your application to process. Please do not close this window until you see the thank you message.)