Application for Employment

Phone: 800-424-1011 or 585-424-5300
Fax: 585-424-1064
Please complete all of the required information below.*
How did you hear about us?

Personal Information
*First name:
Middle initial:
*Last name:
*Street address 1:
Street address 2:
*Email:
*City:
*State:
*Zip:
Home phone:
*Cell phone:

General Information
*Position(s) applying for:
*Date available:
*Available to work:
Full-time
(M - Thurs 8:30-5:30, F 8:30-4:30)



Part-time



Temporary



Flexible
*Are you employed now?
Yes

No
For Part-Time, Temporary, or Flexible, list days/hours you are available to work:
*Rate of pay desired:
*Typing speed (WPM):
*Have you worked at StoreSMART before?
Yes

No
If yes, date:
*Have you applied at StoreSMART before?
Yes

No
If yes, date:
Do you have relatives working for StoreSMART?
Yes

No
If yes, names:
*Do you have reliable transportation?
Yes

No
*Are you under 18 years of age?
Yes

No
If yes, can you furnish a work permit?
Yes

No
*Are you legally authorized to work in the United State?
Yes

No
Are you capable of performing the essential functions of the job for which you are applying with or without a reasonable accomodation?
Yes

No

Education

High School
*School name, location:
*Degree/major:

College 1
College name, location:
Degree/major:

College 2
Colege name, location:
Degree/major:

College 3
College name, location:
Degree/major:
Describe any specialized training, apprenticeship, skills and extra-curricular activities that are relevant to your ability to perform the job.

Employment History
Begin with current or last job

Job 1
Employer:
Address:
Start date:
End date:
Immediate supervisor name:
Phone:
Job title:
Job duties:
Reason for leaving:
Starting rate of pay:
Final rate of pay:

Job 2
Employer:
Address:
Start date:
End date:
Immediate supervisor name:
Phone:
Job title:
Job duties:
Reason for leaving:
Starting rate of pay:
Final rate of pay:

Job 3
Employer:
Address:
Start date:
End date:
Immediate supervisor name:
Phone:
Job title:
Job duties:
Reason for leaving:
Starting rate of pay:
Final rate of pay:

Job 4
Employer:
Address:
Start date:
End date:
Immediate supervisor name:
Phone:
Job title:
Job duties:
Reason for leaving:
Starting rate of pay:
Final rate of pay:

Additional Information

Unemployment

Account for all periods of time, three months or more, between positions held or after school
From:
To:
How did you spend this time:
From:
To:
How did you spend this time:
Are there reasons we should not contact your prior employers for verification of employment?
Yes

No
If yes, please explain:

Military Service Record
*Were you in U.S. Armed Forces?
Yes

No
If yes, which branch?
Did you receive any training in the U.S. Army Forces that is relevant to the position applied for?
Yes

No
If yes, list training:

Professional Designations
Designation:
Organization granting designation:
Date completed:
Designation:
Organization granting designation:
Date completed:

Professional Licenses
Type of license:
State granting license:
License number:
Type of license:
State granting license:
License number:
Please email your resume to [email protected].

Professional References

Reference 1
Name:
Occupation:
Company:
Address:
Relationship:
Phone number:

Reference 2
Name:
Occupation:
Company:
Address:
Relationship:
Phone number:

Reference 3
Name:
Occupation:
Company:
Address:
Relationship:
Phone number:

Please read carefully before submitting application

I have submitted the attached form to the company for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate the company to further process my application.

My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials, is true and complete to the best of my knowledge and also constitutes authority to verify any and all information submitted on this application. I understand that any misrepresentation or omission of any fact in my application, resume or any other materials, or during any interviews, can be justification for refusal of employment, or, if employed, termination from the Company’s employ.

I also affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of employment with the Company in the position I am seeking.

I understand that this application is not an employment contract for any specific length of time between the Company and me, and that in the event I am hired, my employment will be “at will” and either the Company or I can terminate my employment with or without cause and with or without notice at any time. Nothing contained in any handbook, manual, policy and the like, distributed by the Company to its employees is intended to or can create an employment contract, an offer of employment or any obligation on the Company’s part. The Company may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy practice, condition or process affecting its employees.

References: I hereby authorize the company and its agents to make such investigations and inquires into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize the company and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.

Temporary/Contract Employment: If employed as a temporary or contract employee, I understand that I may be an employee of the company and not of any client. If employed, I further understand that my employment is not guaranteed for any specific time and may be terminated at any time for any reason. I further understand that a contract will exist between the company and each client to whom I may be assigned which will require the client to pay a fee to the company in the event that I accept direct employment with the client, I agree to notify the company immediately should I be offered direct employment by a client (or by referral of the client to any subsidiary or affiliated company), either for a permanent, temporary (including assignments through another agency), or consulting positions during my assignment or after my assignment has ended.

*I understand
*Do you agree?
I agree

I do not agree
Today's date: