Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Are you 18 years old or older?
*
Yes
No
Are you either a U.S. citizen or an alien authorized to work in the U.S.?
*
Yes
No
Desired Positions
*
Have you ever worked or attended school under another name? If so, under what name?
*
Do you have reliable transportation?
*
Yes
No
Have you ever been fired from a job?
*
Yes
No
Do you have experience with POS systems?
*
Yes
No
Desired Location
*
Desired Position
*
Do you prefer:
*
Full-time
Part-time
Hours per week desired:
*
Hours you are available to work:
*
Days of week you are available to work:
*
Are you available to work weekends?
*
Yes
No
Are you available to work holidays?
*
Yes
No
Are you available to work nights?
*
Yes
No
Are you available to work overtime?
*
Yes
No
Available Start Date
*
MM
DD
YYYY
Did you graduate from high school?
*
Yes
No
Did you graduate from College/University/Tech School?
*
Yes
No
Course of Study:
Other education, training or special skills:
Employer:
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Start and End Dates
Position Held:
*
Reason for leaving:
*
Supervisor’s Name & Title:
*
May we contact?
Yes
No
Description of Duties:
*
Starting Hourly Pay:
*
Final Hourly Pay:
*
Employer 2:
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Start and End Dates
Position Held:
Reason for leaving:
Supervisor’s Name & Title:
May we contact?
Yes
No
Description of Duties:
Starting Hourly Pay:
Final Hourly Pay:
Employer 3:
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Start and End Dates
Position Held:
Reason for leaving:
Supervisor’s Name & Title:
May we contact?
Yes
No
Description of Duties:
Starting Hourly Pay:
Final Hourly Pay:
Authorization and Acknowledgements
*
I certify that I have not knowingly withheld any information that might affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure this employment can be grounds for rejection of my application or, if I am employed by this company, can be grounds for my immediate termination from the company.
I permit the company to check and verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any and all information listed above.
Candidate’s Signature
*
Date
*
MM
DD
YYYY
