APPLICATION FOR EMPLOYMENT
RESET FORM
Date: Name: (Last) Street Address: City/State/ZIP: (First) (Middle)
PERSONAL INFORMATION
Social Security Number: Position Desired: Minimum Salary Required:
Check One: Full-Time Part-Time Temporary/Seasonal Are you at least 16 years old? Yes No
IF YOU ARE UNDER 18, YOU MAY BE REQUIRED TO PROVIDE A WORK PERMIT PRIOR TO WORKING IF REQUIRED IN YOUR STATE
Telephone: E-mail Address:
Mobile/Work/Other:
Please indicate the hours you are available to work SUN MON TUES WED THURS
FRI
SAT
Have you worked for our company, including any of its divisions, before? Yes No If yes, give dates: From: __________ To: ___________ Division/Location:
Do you have any relatives currently employed by our company? If yes, identify name(s), position, and location:
Yes
No
WORK EXPERIENCE
Employer Address: Phone: Reason for Leaving: MAY WE CONTACT YOUR CURRENT EMPLOYER? Employer Address: Phone: Reason for Leaving: YES NO Starting Position/Salary: Last Position/Salary: Supervisor (Name/Title): Dates of Employment: From: To: Starting Position/Salary: Last Position/Salary: Supervisor (Name/Title): Dates of Employment: From: To: LIST PREVIOUS EXPERIENCE BEGINNING WITH CURRENT OR MOST RECENT POSITION Starting Position/Salary: Last Position/Salary: Supervisor (Name/Title): Dates of Employment: From: To:
Employer Address: Phone: Reason for Leaving:
REFERENCES (Business or professional, do not list relatives)
Name and Position Address Phone How acquainted and length of time acquainted Name and Position Address Phone How acquainted and length of time acquainted
EDUCATION AND TRAINING
EDUCATION LOCATION YEARS COMPLETED DEGREE / DIPLOMA Yes Yes No No TYPE OF COURSE/MAJOR
College High School Additional Training
REFERRAL SOURCE
Walk-in Applicant Newspaper Ad Internet Ad Store Sign Employee Referral Company Website Other _______________
ADDITIONAL PERSONAL INQUIRIES
Have you ever been convicted of a felony? Yes No Yes No
Have you ever been convicted of a misdemeanor related to theft or the misappropriation of funds?
If you answered yes to either question above, please explain: __________________________________________________________________________ (In California only: Do not answer if your conviction was solely for a marijuana-related offense that is more than two years old or if you successfully completed a pre-trial or post-trial diversion program.) ____________________________________________________________________________________________________________________________
A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. EACH CASE IS CONSIDERED INDIVIDUALLY; HOWEVER, FAILURE TO DISCLOSE INFORMATION WILL BE SUFFICIENT CAUSE TO ELIMINATE APPLICANT FROM FURTHER CONSIDERATION FOR EMPLOYMENT OR MAY RESULT IN IMMEDIATE TERMINATION WHENEVER IT IS DISCOVERED.
PERMISSION TO WORK
Are you legally authorized for employment in the United States? Yes No If employed you will be required to provide
