Application for Employment Form
We understand that everyone has busy lives, so we have provided this form for your convenience when it suits your schedule.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone/Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you 18 years of age or older?
*
Yes
No
Position Applying For?
*
Cashier
Warehouse
In-Store Customer Service
Other
If Other - Please Specify
Please be as descriptive as you can.
This position involves heavy lifting, do you have any lifting limitations?
*
Yes
No
Have you had any previous injury or surgery to your back or neck?
*
Yes
No
Date Available to Start
*
-
Month
-
Day
Year
Please choose a date
Days You are Available for Work
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Hours You Are Available for Work
*
Mornings
Afternoons
Evenings
Hours Requested per Week
*
Type the number of hours you wish to work per week.
Wage Requirements
*
Please type in the wage requirement you expect per hour.
Have you ever been previously employed by The Stock Market Country Store?
*
Yes
No
If yes, when and where?
Location and dates to the best of your knowledge
Have you ever been convicted of a felony?
*
Yes
No
If Yes - please explain
Record of conviction does not automatically disqualify applicant from employment consideration.
Education
Please fill out the Education portion of this Form to the best of your ability.
High School Name
High School Diploma?
Yes
No
College Name
College Major
College Degree
Previous Employment
Please fill out this section starting with your last Employer to the best of your knowledge
Name of Employer 1
Position Held - Employer 1
Duties - Employer 1
Employment Dates - Employer 1
ex: MM/DD/YYYY to MM/DD/YYYY
Wages - Employer 1
Employer 1 - Supervisor Name
First Name
Last Name
Employer 1 - Reasons for Leaving
Name of Employer 2
Position Held - Employer 2
Duties - Employer 2
Employment Dates - Employer 2
ex: MM/DD/YYYY to MM/DD/YYYY
Wages - Employer 2
Employer 2 - Supervisor Name
First Name
Last Name
Employer 2 - Reasons for Leaving
Name of Employer 3
Position Held - Employer 3
Duties - Employer 3
Employment Dates - Employer 3
ex: MM/DD/YYYY to MM/DD/YYYY
Wages - Employer 3
Employer 3 - Supervisor Name
First Name
Last Name
Employer 3 - Reasons for Leaving
References
Please fill out this section with 3 personal or professional references.
Reference 1 - Name
First Name
Last Name
Reference 1 - Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 1 - Years Known
Reference 2 - Name
First Name
Last Name
Reference 2 - Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 2 - Years Known
Reference 3 - Name
First Name
Last Name
Reference 3 - Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 3 - Years Known
Drug Free Workplace
Our business is a certified Drug Free Workplace as rated by the State. Therefore, there is no smoking, vaping, or use of substances other than prescription or over the counter items such as aspirin, digest aids like Tums, or antibiotic creams sprays etc. like Neosporin anywhere on the property.
Certification and Signature
I certify that the information on this application is true and correct to the best of my knowledge and I understand that any misrepresentation or omission of fact shall be cause for disqualification for employment or dismissal from employment. I hereby authorize an investigation of statements contained in the application and release from all liability and claims all persons and companies supplying information. I understand that my employment with the company would not be for any fixed period of time and that, if employed, I may resign at any time for any reason or the company my terminate my employment at any time for any reason.
Signature
*
Date
*
MM/DD/YYYY
Submit
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