Employment Application
Name
First Name
Last Name
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
Date
-
Month
-
Day
Year
Date
Position applying for
Floor Staff
Shift Manager
General Manager
Hours desired per week
please enter a number less than or equal to 40
Are you 18 or older?
*
Yes
No
Are you vaccinated against Covid-19?
*
Yes
No
Prefer not to answer
When are you able to start?
Have you ever been convicted of a crime other than a minor traffic violation?
*
Yes
No
Are there any felony charges pending against you?
*
Yes
No
If so, please state citation, date, and place where offense occurred.
Education History
High School
How Long?
Graduate?
College Attended
How Long?
Graduate?
Previous Work Experience
Employer
From
To
Address
Job Title
Supervisor
Phone Number
Please enter a valid phone number.
Wage
Reason for Leaving
Employer
From
To
Address
Job Title
Supervisor
Phone Number
Please enter a valid phone number.
Wage
Reason for Leaving
Employer
From
To
Address
Job Title
Supervisor
Phone Number
Please enter a valid phone number.
Wage
Reason for Leaving
May we contact employers listed
*
Yes
No
If not, which one(s)
Availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
(ie All day, After 5:00, Before 3:00)
References
Name
Phone
Name
Phone
Name
Phone
In a brief paragraph, please explain why you would wish to work here and add any further information for us to consider.
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