Job Application

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Pinkie's administers Pre-Employment Drug Testing and Checks Driving Record
It is our policy to provide equal employment opportunities and will not unlawfully consider any factors of race, religion, age, creed, national origin, gender, disability, sexual orientation, veteran status, genetic information or any and all other unlawful biases regarding federal, state or local laws with regard to workers or applicants.

TO BE CONSIDERED FOR EMPLOYMENT, ALL APPLICANTS MUST FILL OUT THIS FORM COMPLETELY. THIS APPLICATION WILL BE GIVEN EVERY CONSIDERATION, BUT ITS RECEIPT DOES NOT IMPLY THAT THE APPLICANT WILL BE EMPLOYED BY OUR COMPANY. THIS FORM BECOMES A PART OF YOUR EMPLOYMENT RECORD IF YOU ARE HIRED. THIS APPLICATION IS ONLY VALID FOR 30 DAYS.
Personal Information
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail*
myname@example.com
Are you over 21?*

YesNo
If you have lived at above address less than 12 months, list previous address (including city, state, zip):
Have you worked or do you have work experience or education under a different name?

YesNo
If so, please list (including first, middle and last names):
Can you supply documentation of your identity and authorization to work in the U.S.?*

YesNo
Have you ever been convicted or plead guilty or no contest to any criminal offense? (Criminal convictions are not an automatic ban from employment but will only be considered in relation to specific job requirements).*

YesNo
If yes, state the offense, location, date and disposition, and any other circumstances or rehabilitation.
Work Interest

Working at Pinkie's, Inc. requires holiday, night and weekend shifts and shifts are subject to change at the discretion of the store Manager.
Position applied for:
Type of employment:

Full TimePart TimeOther
Shift Preferred:
Minimum Salary:
Date You Are Available For Employment

MonthDayYear
Have you ever worked for our company before?*

YesNo
When and Where?
Do you have any relatives or friends that have worked for our company?*

YesNo
When and Who?
Would you accept part time work?

YesNo
Shift & hours you can work:

1st Shift2nd Shift3rd Shift
Please indicate the hours you would be willing to work whenever scheduled or requested:
Briefly state your reason of interest in employment with our company or any other comments with regard to work interest:
Do you have reliable transportation?

YesNo
If the position requires travel, are you willing, and do you have a valid drivers license?

YesNo
If Yes, Driver's License #
State
Are you currently employed?*

YesNo
May we inqure of you current employer?

YesNo
Work History

List the names of employers in consecutive order with present or last employer listed first. account for all periods including military services. If self-employed, give firm name and supply additional references.
Most Recent Employer
Employer's Name
Supervisor's Name
Nature of Business
Position Held
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Start Date

MonthDayYear
End Date

MonthDayYear
Starting Pay
Ending Pay
Telephone

Area CodePhone Number
Reason for Leaving
Duties
Employer 2
Employer's Name
Supervisor's Name
Nature of Business
Position Held
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Start Date

MonthDayYear
End Date

MonthDayYear
Starting Pay
Ending Pay
Telephone

Area CodePhone Number
Reason for Leaving
Duties
Employer 3
Employer's Name
Supervisor's Name
Nature of Business
Position Held
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Start Date

MonthDayYear
End Date

MonthDayYear
Starting Pay
Ending Pay
Telephone

Area CodePhone Number
Reason for Leaving
Duties
Employment Questions
Please explain any periods of unemployment
Have you ever been disciplined associated with theft?*

YesNo
Have you ever been terminated from employment?*

YesNo
Have you ever served in the military?

YesNo
Education

List of Schools Attended

	Name	City	No. of Years	Year of Graduation	Type of Degree	Major Course of Study
High school
College/University
College/University
College/University
College/University
Graduate School
Business Technical

If you have not graduated from High School, do you have a GED?

YesNo
If you went to college but did not graduate, how many credit hours are needed for your degree?
For an Associate's degree
For a Bachelor's degree
List any scholarships, academic honors, awards or special achievements:
List languages which you speak proficiently:
List languages which you read proficiently:
Certifications/Licenses

Please list any that you may have.

	Type	Agency or State Issued	Date Issued	Certification/License Number
1
2
3
4

References
1st Name
Address
Phone
Occupation
2nd Name
Address
Phone
Occupation
3rd Name
Address
Phone
Occupation
Special Skills
List those skills and abilities (personal skills, qualities, work style, interpersonal ability, communication, etc.) you feel particularly qualify you for a position with us.
Additional Terms and Conditions of Employment

Affidavit
I certify that the answers given by me to the foregoing questions and statements on the employment application and/or during the employment interview process are true and correct without any consequential omissions of any kind whatsoever. I understand that any misleading or incorrect statements may render this application void and, if employed, would be cause for my termination. I further agree that the Company shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this application.*
Initials
I understand that this application is designed for use with several types of jobs and some questions may not be completely applicable to the position for which I am applying.*
Initials
I authorize the companies, schools, persons or entities given during the employment process, and the employer (if employed), while employed, or during internal investigations, as references or past employers or affiliations, to give any information regarding my employment, character, qualifications, certifications and licenses, and hereby release said companies, schools, persons or entities from all liability for any damage for issuing this information. A favorable result may be a condition of employment, commencement, or continuation of any employment duties where elements are job-related.*
Initials
I understand that I may be required to have a medical examination and/or drug and alcohol test after an offer of employment has been made and prior to the commencement of my employment duties. A favorable result on the medical examination and/or drug and alcohol test would be a condition of my employment or commencement of any employment duties.*
Initials
I realize that operating conditions may require me to work shifts or work hours scheduled other than the one for which I am applying and I agree to such scheduling change as directed by my supervisor or the management.*
Initials
I understand that my employment is not for a specified or definite term and that I may resign, or I may be discharged, at any time, for any reason, with or without good cause and with or without prior notice. I further understand that this policy cannot be changed or amended except by written agreement signed by me and by a corporate officer. I understand that this is an application for employment and that no employment contract is being offered.*
Initials
I understand that only United States citizens or aliens who are legally entitled to work in the United States are eligible for employment.*
Initials
My employment shall be in accordance with the terms of this application, all safety and incident reporting rules, and all other Company rules and regulations. The Company shall have the right to amend, modify, or revoke its rules and regulations at any time. I will familiarize myself promptly with such rules and regulations and will abide and be bound by the rules and regulations now or hereafter in effect.*
Initials
I certify that as a part of the application process, I have been provided with a written job description or have had the opportunity to review and/or discuss the requirements for the position*
Initials
I certify that I understand each requirement and that I am capable of meeting each and every requirement.*
Initials
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Pinkie's administers Pre-Employment Drug Testing and Checks Driving Record

Personal Information

Work Interest

Work History

Most Recent Employer

Employer 2

Employer 3

Employment Questions

Education

If you went to college but did not graduate, how many credit hours are needed for your degree?

Certifications/Licenses

References

Special Skills

Additional Terms and Conditions of Employment