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Employment Information
General Information
Location of Store
Today's Date
Your Name    
Social Security Number
Street Address    
City   State
 
Zip    
   
Telephone:    
Home    Work
 
Have you worked for our company before?
Yes   No
 
If yes, please answer the following questions.
Where:  
When:  
Your Final Position:  
Have you ever applied to our company before?
Yes   No
 
If yes, please answer the following questions.
Where:  
Your Reason for leaving the job:
Position desired
Minimum Salary desired
Date Available For Work
I am interested in:
Full time - 30 to 40 hrs. per week
Part time - 0 to 30 hrs per week
Seasonal - Holidays / Summer
Are You Over 18 years of age?
Yes  
No  
(If you are less than 18 years old, you may be required to provide a work permit prior to working)
Please indicate the hours you are available for work during both day and evening
Sun
Mon
Tue
Wed
Thurs
Fri
Sat
Do you have any relatives now employed by our company?
Yes
 
No
 
If yes, please identify by their Name(s), Position and Location
 
Work Experience
List your previous experience, beginning with your current or most recent position.
 
1. Employer
Street Address
City State Zip
   
Phone Number
Supervisor
Name / Title
Reason for leaving:
 
Starting Position Starting Salary
Most recent position Most recent salary
Duties:  
Date of employment  
Start: Date Year
 
End: Date Year
 
2. Name of your previous employer
Street Address
City State Zip
   
Phone Number
Supervisor
Name / Title
Reason for leaving:
 
Starting Position Starting Salary
Most recent position Most recent salary
Duties:  
Date of employment  
Start: Date Year
 
End: Date Year
 
3. Employer
Street Address
City State Zip
   
Phone Number
Supervisor
Name / Title
Reason for leaving:
 
Starting Position Starting Salary
Most recent position Most recent salary
Duties:  
Date of employment  
Start: Date Year
 
End: Date Year
 
References
Individuals not related to you. Business references preferred
Reference
Street Address
City State Zip
Phone Job Title  
 
 
How acquainted and for how long?
Reference
Street Address
City State Zip
Phone Job Title  
 
 
How acquainted and for how long?
 
Education & Training
Please provide Name, Street, City and Zip code for each school
Name of School
Name & Address
Number of years Completed
Degree
Type of Courses / Major
College
High School
Additional Training
Foreign Languages
Spoken Fluently
Yes No
For office positions, please indicate the jobs which you have performed:  
Typing: Yes No
Words per minute    
10 Key  
 
 
   
   
By Touch By Sight
Computer Software(s)
Others
   
Additional Employment History Enquiries
Have you ever been dismissed or forced resign from any employment?
  Yes No
 
If yes, please explain.  
 
 
Have you ever been convicted of a felony crime or theft-related misdemeanor within last 7 years?
  Yes No
 
If yes, please state details: Convictions will not necessarily disqualify the applicant, each case is considered indiviually.
 
 
Permission to Work
Are you legally authorized to work in United States? Yes No
Will you now or in future require sponsorship for employment visa status (H1-B Status)? Yes No
 
Referal Source
Walk-inApplicant Newspaper Ad Employee Referral (Name)
Community / Organization (Name)
Community / Organization (Name)
School / College (Name)
Website (Name )
Others (Please list)
 
Additional Questions
1. Why are you interested in working for our company?
2. What strengths would you bring to our company?
3. What didin't you liked about your previous job(s)?
 
Please attach your resume here.
Applicant's Authorization
I hereby confirm that all the information given above is true to best of my knowledge and information.
 
 
 
 
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