Employment Application

Employment Application

Mercury Sports an equal opportunity employer. Applicants will be considered regardless of race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status. Equal access to the hiring process, services, and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the Human Resource Representative.

Each question should be answered completely and accurately.

Full Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail

example@example.com

Wage expectations

Work Hours

How did you hear about this postion?

Are you over the age of 18?

Are you eligible to work in the United States?

Are you currently employed?

Date available for work

Date

What hours are you available?

Have you been convicted of a felony/misdemeanor (other than traffic violations)?

If yes, provide the location, date and result/outcome for each conviction (enter NONE if no convictions)

EDUCATION

Highest level of education completed:

Please complete the appropriate sections

Rows	Name & Location of School	Number of Years Attended	Did You Graduate?	Degree or Certification
GED / High School
Trade School
College

WORK HISTORY

Please list your four most recent employers, list the most recent first

1. EMPLOYER

Employer's Name (Most current)

Address & location of business

Your title

May we contact this employer?

Supervisor's name

First and Last Name

Phone number

Format: (000) 000-0000.

Start date

MonthDayYear

End date

MonthDayYear

Wage

Work performed:

Reason for leaving

2. EMPLOYER

Employer's Name (Second most recent)

Address & location of business

Your title

May we contact this employer?

Supervisor's name

First and Last Name

Phone number

Format: (000) 000-0000.

Wage

Start date

MonthDayYear

End date

MonthDayYear

Work performed:

Reason for leaving

3. EMPLOYER

Employer's Name (Third most recent)

Address & location of business

Your title

May we contact this employer?

Supervisor's name

First and Last Name

Phone number

Format: (000) 000-0000.

Wage:

Start date

MonthDayYear

End date

MonthDayYear

Work performed:

Reason for leaving

Do you have a U.S. military service record?

If yes, branch of service

Discharge date and rank

List job-related skills, experience or accomplishments.

List any additional information you would like us to consider:

REFERENCES

List three professional references, (business or work, not relatives) that you have known for at least one year. List at least one previous supervisor.

1. Full Name

First NameLast Name

Company

Best Contact Number

Format: (000) 000-0000.

Years acquainted

Relationship

2. Full Name

First NameLast Name

Company

Best Contact Number

Format: (000) 000-0000.

Years acquainted

Relationship

3. Full Name

First NameLast Name

Company

Best Contact Number

Format: (000) 000-0000.

Years acquainted

Relationship

AUTHORIZATION

I understand that Mercury Sports iss making no employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination, if employed.

I authorize Mercury Sports to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job-related. I give my full consent for all contacted individuals, including former employers, to provide information concerning this application, and I waive my right to bring any cause of action against these individuals for any and all liability for damages arising from furnishing the requested information to Mercury Sports. I acknowledge that a facsimile and/or photocopy of this form is as valid as the original.

Pre-employment testing may be required (drug testing, background checks, physical examinations, motor vehicle checks).Testing may be applicant or employer paid based on the employer.I understand that any offer of employment may be withdrawn if drug tests are positive and/or if a condition is discovered for which no reasonable accommodation can be made.

I understand that this application is current for 60 days. At the conclusion of this time, if I have not heard from Mercury Sports and still wish to be considered for employment, it will be necessary to complete a new application.

I understand that if hired, employment is at-will, regardless of the employer, and may be terminated by myself, the employer or Mercury Sports at any time, with or without cause or notice, for any reason or no reason.

By entering your name, you agree to accept the terms of the above document with an electronic signature.

Type signature

Date

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