Application For Employment
Flix Up
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Driver's License Number
Do you have your own car?
*
Yes
No
Have you ever been convicted of, entered a plea of guilty, no contest, or had a withheld judgement to a felony?
*
Yes
No
If yes, please explain.
What type of work are you seeking?
Part Time
Full Time
Availability
Please tell us your available hours for each day.
Desired Location
Please Select
Westmoreland Mall
Monroeville Mall
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you a student?
Yes
No
If yes, please include your typical class schedule and extra curricular activities.
Previous Employment
Company Name
Phone Number
Please enter a valid phone number.
Address
Supervisor's Name
Job Title
Start Date
-
Month
-
Day
Year
Date
Stop Date
-
Month
-
Day
Year
Date
Are you currently still employed here?
Yes
No
Reason for Leaving
May we contact this employer?
Yes
No
Phone Number
Please enter a valid phone number.
Are you currently still employed here?
Yes
No
Reason for Leaving
Company Name
Phone Number
Please enter a valid phone number.
Address
Supervisor's Name
Job Title
Start Date
-
Month
-
Day
Year
Date
Stop Date
-
Month
-
Day
Year
Date
Are you currently still employed here?
Yes
No
Reason for Leaving
May we contact this employer?
Yes
No
References
Reference #1 Name
Phone Number
Please enter a valid phone number.
Relationship
Years Known
Reference #2 Name
Phone Number
Please enter a valid phone number.
Relationship
Years Known
Questionnaire
How did you hear about us?
What about this company or job interested you?
Do you like to keep up on and follow trends and current events online?
Yes
Not Really
Please select the answer to each statement as it applies to you.
Strongly
Disagree
Disagree
Neutral
Strongly Agree
I feel comfortable in a customer service and retail job.
I feel comfortable working in an environment heavily based in social media.
I am tech savvy.
I am good at multitasking.
If you wish to share any of your social media handles, we would love to see them!
Instagram
Facebook
Twitter
TikTok
Other (please specify)
Other (please specify)
Almost done!
I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company may be terminated.
Name
First Name
Last Name
Signature
Today's Date
-
Month
-
Day
Year
Date
Submit
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