WILLI'S APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Select a Location
How were you referred to this company?
Please Describe
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Mobile Phone
Format: (000) 000-0000.
Emergency Contact Name
Emergency Contact Relation
Emergency Contact Phone
Format: (000) 000-0000.
NO ONE WILL BE DENIED EMPLOYMENT SOLELY BECAUSE OF CITIZENSHIP, PHYSICAL LIMITATIONS OR CONVICTION RECORD
Are you legally authorized to work in the United States without restriction?
Do you have any physical limitations restricting you from physical labor?
Have you ever been convicted of a felony or misdemeanor?
Please Describe
Position Desired
Date you can start

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Days and Hours available.

Rows	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
Hrs. Ex 1-9

Do you participate in
Have you ever applied to Willi's before?
Which location?
When?
Have you ever been employed by Willi's before
Last Supervisor at Willi's
Location
Reason for leaving
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

EDUCATION

Rows	Name of Institution	Years Attended	Did you Graduate
Primary School
High School
College or University
Trade / Tech / Other
Graduate School

Area of Study/Degree
Other skills or qualifications
Military Service
Branch of Service
Discharge Date and Rank

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Present Membership in National Guard or Reserves?
Obligation end date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
FORMER EMPLOYERS List below your current/previous employers, starting with the most recent one.
Name of Present Employer
May we contact them
Position
Starting Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Supervisor
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Description of Duties
Reason For Leaving
Name of Previous Employer
Position
Starting Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Ending Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Supervisor
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Description of Duties
Reason For Leaving

References Give below the names of three persons not related to you, whom you have known at least one year.

Rows	Name	Phone	Occupation	Yrs Acquanted
1st
2nd
3rd

AUTHORIZATION
"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, ormisrepresentations are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at either my or the company option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or with out notice, at any time by the company. I understand that no company representative, other than its president and then only when in writing and signed by the president, has any authorityto enterinto any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. I understand 'Bonding'or an in-depth background check may be required. I understand that the company is an equal opportunity employer. In accordance with all federal, state and local laws, employees shall be recruited, hired, compensated, trained, developed, evaluated, disciplined, placed, promoted, laid off and terminated equally and fairly. I understand that the company will be impartial in all of its relations with its employees and applicants for employment without regard to race and color, national origin, citizenship, religion, sex, age, marital status, veteran status, physical disability, or medical condition, except when such a characteristic is an appropriate and bona fide occupational qualification."
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination
Should be Empty:

APPLICATION FOR EMPLOYMENT

NO ONE WILL BE DENIED EMPLOYMENT SOLELY BECAUSE OF CITIZENSHIP, PHYSICAL LIMITATIONS OR CONVICTION RECORD

Military Service

AUTHORIZATION