EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

Full Name:*

First NameMiddle NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email:

example@example.com

Phone Number:

Please enter a valid phone number.

Date of Birth:*

Date

SOCIAL SECURITY NUMBER (SSN):*

DATE AVAILABLE:

DESIRED PAY: $

HOURLY

EMPLOYMENT DESIRED:

Full TimePart TimeSeasonal

POSITION APPLIED FOR:

EMPLOYMENT ELIGIBILITY

ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S?

YESNO

HAVE YOU WORKED IN SMOKE SHOP / VAPE SHOP?

YESNO

HOVE YOU EVER BEEN CONVICTED OF A FELONY?

YESNO

*IF YES. PLEASE EXPLAIN:

HAVE YOU EVER WORKED FOR THIS EMPLOYER?

*IF YES WRITE THE START AND END DATES:

WORK SKILLS:

	NO EXPERIENCE	SOME WHAT EXPERIENCE	VERY EXPERIENCE
WATER PIPE / GLASS ACCESSORIES
E-CIG
VAPORIZERS
CBD
KRATOM
CIGARS

EDUCATION

HIGH SCHOOL:

CITY / STATE:

FROM:

Date

TO:

Date

GRADUATE?

YESNO

COLLEGE:

CITY / STATE:

FROM:

Date

TO:

Date

PREVIOUS EMPLOYMENT

EMPLOYER 1:

COMPANY / INDIVIDUAL

Phone Number:

Please enter a valid phone number.

Email:

example@example.com

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

SALARY PAY: $

JOB TITLE:

RESPONSIBILITES:

REASON FOR LEAVING:

FROM:

Date

TO:

Date

EMPLOYER 2:

COMPANY / INDIVIDUAL

Phone Number:

Please enter a valid phone number.

Email:

example@example.com

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

SALARY PAY: $

JOB TITLE:

RESPONSIBILITES:

REASON FOR LEAVING:

FROM:

Date

TO:

Date

EMPLOYER 3:

COMPANY / INDIVIDUAL

Phone Number:

Please enter a valid phone number.

Email:

example@example.com

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

SALARY PAY: $

JOB TITLE:

RESPONSIBILITES:

REASON FOR LEAVING:

FROM:

Date

TO:

Date

REFERENCES

(PROFESSIONAL ONLY)

FULL NAME:

First NameLast Name

RELATIONSHIP:

COMPANY:

NAME

TITLE:

POSITION

EMAIL:

example@example.com

PHONE NUMBER:

Please enter a valid phone number.

FULL NAME:

First NameLast Name

RELATIONSHIP:

COMPANY:

NAME

TITLE:

POSITION

EMAIL:

example@example.com

PHONE NUMBER:

Please enter a valid phone number.

FULL NAME:

First NameLast Name

RELATIONSHIP:

COMPANY:

NAME

TITLE:

POSITION

EMAIL:

example@example.com

PHONE NUMBER:

Please enter a valid phone number.

MILITARY SERVICES

ARE YOU A VETERAN?

YESNO

BRANCH:

RANK AT DISCHARGE:

FROM:

Date

TO:

Date

TYPE OF DISCHARGE:

IF NOT HONORABLE, PLEASE EXPLAIN:

BACKGROUND CHECK CONSENT

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK?*

YESNO

DISCLAIMER

Applicant understands that this is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.

Please complete each section EVEN IF you decide to attach a resume.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.

File Upload

Signature

Date

FULL NAME:

First NameLast Name