Employment Application Form

Employment Application Form
Application Date:

MonthDayYear
Name:*
Last, First, M.I.
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.
Present Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Applied For:
Based on Previous Experience, What rate of pay is expected?
Date Available:

MonthDayYear
Position Type:

Full TimePart TimeTemporary
Are you able to perform the essential job functions of the position you are applying for?
If hired, will you be able to work overtime?
Are you available any of the 7 days a week we are open?
Are you at least 18 years of age?
I understand Roselawn True Value is a smoke free environment.
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by court?
A yes response does not automatically disqualify your application.
If yes, please explain.
Education Information:
High School:
Name & Dates
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Degree?
Vocation/ Business/ Other:
Name & Date
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Major Studies:
Degree, Diploma, License or Certificate:
College/ University:
Name & Date
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Major Studies:
Degree, Diploma, License or Certificate:
Other Special Knowledge, Skills or Qualifications:
List any construction or manufacturing equipment, office skills, technical equipment or training
Military Service
List dates, ranks, and training
Proficient with POS Systems?
Computer Skills
Hardware/ Software
Employment History:

List all employers, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.
Employed From - To:
06/2004 - 06/2014
Job Title:
Starting Salary: $
Ending Salary: $
Employer Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name:

First NameLast Name
Supervisor Phone:
Please enter a valid phone number.
Job Duties & Responsibilities:
Reason for Leaving:
Employed From - To:
06/2004 - 06/2014
Job Title:
Starting Salary: $
Ending Salary: $
Employer Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name:

First NameLast Name
Supervisor Phone:
Please enter a valid phone number.
Job Duties & Responsibilities:
Reason for Leaving:
Employed From - To:
06/2004 - 06/2014
Job Title:
Starting Salary: $
Ending Salary: $
Employer Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name:

First NameLast Name
Supervisor Phone:
Please enter a valid phone number.
Job Duties & Responsibilities:
Reason for Leaving:
Certification & Authorization:

The above information is true and correct.
I authorize the Company to inquire into my education, past employment history, and references as needed to research my qualifications for this position.

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for the completion of Form I-9.
If considered for employment I am willing to submit to the following:
Background Check:
Drug Screening:
I understand Roselawn True Value has a 90-day probation period:
I hereby acknowledge that I have read and agree to the above statements.

Roselawn True Value is an equal opportunity employer and administers all personnel practices without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity or expression, marital status, veteran status, genetics or any other category protected under applicable law.
Signature:

Clear
Printed Name:
Date:

MonthDayYear
File Upload

Resume, Cover Letter, Other Info to help you stand out.
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Employment Application Form

Education Information:

Employment History:

Certification & Authorization:

If considered for employment I am willing to submit to the following: