Please choose position you are applying for.

            Warehouse Employee

                     
            Sales Associate

Personal Information

Name in Full
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
E-mail

Social Security Number:

Referred by:

Date you can start:

-- dd/mm/yy

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Are you employed?

Yes
No

If yes, may we inquire of your present employer?

Yes
No

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Are you willing to work overtime?

Yes
No

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US Military or Naval service and rank:

If a minor, can you produce the age/work certificate necessary to obtain employment?

Yes
No

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Are you able, at the time of employment, to submit verification of your legal right to work in the US? Verification and completion of the I-9 form must be submitted no later than three business days after date of hire.

Yes
No

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Have you ever been convicted of a felony which is related to the functions or qualification of the position for which you are applying? (A conviction record will not necessarily be a bar to employment.)

Yes
No

If yes, please describe fully the felony conviction (s) listing the nature of the offense (s) and your rehabilitation since the conviction (s).

Educational Background

High school grade completed:

12/GED 11 10 9

High school name and location:

College year completed:

4/Bachelors Degree 3 2/Associates Degree 1

College name and location:

Major area of study:

Trade school name and location:

Major area of study:

Special technical skills (i.e. computer programs used, machines or special tools used):

Work Experience

List below last four employers, starting with your present or most recent place of employment.

Work Experience # 1:

Employer Name
Street Address
Address (cont.)
City
State
Zip Code
Dates Employed
Position
Salary
Name of Supervisor
Reason for Leaving

Work experience # 2:

Employer Name
Street Address
Address (cont.)
City
State
Zip Code
Dates Employed
Position
Salary
Name of Supervisor
Reason for Leaving

Work experience # 3:

Employer Name
Street Address
Address (cont.)
City
State
Zip Code
Dates Employed
Position
Salary
Name of Supervisor
Reason for Leaving

Work experience # 4:

Employer Name
Street Address
Address (cont.)
City
State
Zip Code
Dates Employed
Position
Salary
Name of Supervisor
Reason for Leaving

Personal References

List below three persons not related to you, whom you have known at least three years.

Personal reference # 1:

Name
Occupation
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
Years Known

Personal reference # 2:

Name
Occupation
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
Years Known

Personal reference # 3:

Name
Occupation
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
Years Known

In agreeing to this statement, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I hereby authorize you to conduct any investigation necessary concerning any part of my background related to the position I am seeking. I release all parties from any liability in connection with the provision and use of such information.

I understand and agree that, if employed by this organization, I will abide by its rules and regulations which I understand are subject to change. I further understand that, if hired my employment is for no definite period of time and may be terminated by either party at any time.

Agree
Disagree