Application for Employment

How did you hear about us?

Personal Information

Name:
Address 1:
Address 2:
City:
State:
Zip:
Home phone:
Cell phone:
Email:

General information

Position(s) applying for:

Date available:

Available to work:

Are you employed now:

For Part-Time, Temporary, or Flexible, list days/hours you are available to work:

Rate of Pay Desired:

Typing speed (WPM):

Have you worked for StoreSMART before?
    If yes, date:

Have you applied to StoreSMART before?
    If yes, date:

Do you have relatives working for StoreSMART?
    If yes, names:

Do you have reliable transportation?

Are you under 18 years of age?
    If yes, can you furnish a work permit?

Are you legally authorized to work in the United States?

Are you capable of performing the essential functions of the job for which you are applying with or without a reasonable accomodation?

Education

High school:
Degree:

College 1:
Degree:

College 2:
Degree:

College 3:
Degree:

Specialized training, apprenticeship, skills and extra-curricular activities:

Employment History

Employer 1
Name:
Address:
Start date:
End date:
Immediate supervisor:
Phone:
Job title:
Job duties:
Reason for leaving:
Start pay:
End pay:

Employer 2
Name:
Address:
Start date:
End date:
Immediate supervisor:
Phone:
Job title:
Job duties:
Reason for leaving:
Start pay:
End pay:

Employer 3
Name:
Address:
Start date:
End date:
Immediate supervisor:
Phone:
Job title:
Job duties:
Reason for leaving:
Start pay:
End pay:

Additional Information

Unemployed from to
How did you spend this time:

Unemployed from to
How did you spend this time:

Are there reasons we should not contact your prior employers for verification of employment?
    If yes, explain:

Were you in U.S. Armed Forces?
    If yes, which branch?

Did you receive any training in the U.S. Army Forces that is relevant to the position applied for?
    If yes, list training:

Professional designation:
    Organization:
    Date completed:

Professional designation:
    Organization:
    Date completed:

Professional license:
    State granting license:
    License number:

Professional license:
    State granting license:
    License number:

Professional Reference

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

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

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

Temporary/contract employment:

Do you agree:
Today's date: