EMPLOYMENT / JOB APPLICATION
PERSONAL INFORMATION
Full Name:
*
First Name
Middle Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
example@example.com
Phone Number:
Please enter a valid phone number.
Date of Birth:
*
-
Month
-
Day
Year
Date
SOCIAL SECURITY NUMBER (SSN):
*
DATE AVAILABLE:
-
Month
-
Day
Year
DESIRED PAY: $
HOURLY
EMPLOYMENT DESIRED:
Full Time
Part Time
Seasonal
POSITION APPLIED FOR:
EMPLOYMENT ELIGIBILITY
ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S?
YES
NO
HAVE YOU WORKED IN SMOKE SHOP / VAPE SHOP?
YES
NO
HAVE YOU EVER BEEN CONVICTED OF A FELONY?
YES
NO
*IF YES. PLEASE EXPLAIN:
HAVE YOU EVER WORKED FOR THIS EMPLOYER?
*IF YES WRITE THE START AND END DATES:
WORK SKILLS:
NOEXPERIENCE
SOME WHATEXPERIENCE
VERYEXPERIENCE
WATER PIPE / GLASS ACCESSORIES
E-CIG
VAPORIZERS
CBD
KRATOM
CIGARS
EDUCATION
HIGH SCHOOL:
CITY / STATE:
FROM:
-
Month
-
Day
Year
Date
TO:
-
Month
-
Day
Year
Date
GRADUATE?
YES
NO
COLLEGE:
CITY / STATE:
FROM:
-
Month
-
Day
Year
Date
TO:
-
Month
-
Day
Year
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
City
State / Province
Postal / Zip Code
SALARY PAY: $
JOB TITLE:
RESPONSIBILITES:
REASON FOR LEAVING:
FROM:
-
Month
-
Day
Year
Date
TO:
-
Month
-
Day
Year
Date
EMPLOYER 2:
COMPANY / INDIVIDUAL
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SALARY PAY: $
JOB TITLE:
RESPONSIBILITES:
REASON FOR LEAVING:
FROM:
-
Month
-
Day
Year
Date
TO:
-
Month
-
Day
Year
Date
EMPLOYER 3:
COMPANY / INDIVIDUAL
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SALARY PAY: $
JOB TITLE:
RESPONSIBILITES:
REASON FOR LEAVING:
FROM:
-
Month
-
Day
Year
Date
TO:
-
Month
-
Day
Year
Date
REFERENCES
(PROFESSIONAL ONLY)
FULL NAME:
First Name
Last Name
RELATIONSHIP:
COMPANY:
NAME
TITLE:
POSITION
EMAIL:
example@example.com
PHONE NUMBER:
Please enter a valid phone number.
FULL NAME:
First Name
Last Name
RELATIONSHIP:
COMPANY:
NAME
TITLE:
POSITION
EMAIL:
example@example.com
PHONE NUMBER:
Please enter a valid phone number.
FULL NAME:
First Name
Last Name
RELATIONSHIP:
COMPANY:
NAME
TITLE:
POSITION
EMAIL:
example@example.com
PHONE NUMBER:
Please enter a valid phone number.
MILITARY SERVICES
ARE YOU A VETERAN?
YES
NO
BRANCH:
RANK AT DISCHARGE:
FROM:
-
Month
-
Day
Year
Date
TO:
-
Month
-
Day
Year
Date
TYPE OF DISCHARGE:
IF NOT HONORABLE, PLEASE EXPLAIN:
BACKGROUND CHECK CONSENT
IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK?
*
YES
NO
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.
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FULL NAME:
First Name
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