EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION
PERSONAL INFORMATION
Last name*
First name*
Middle Name*
Type N/A if no middle name
Date Today*

MonthDayYear
Date
Address*

Home Address

Street Address Line 2

CityState

Zip
Home Phone Number
Please enter a valid phone number.
Cellular Phone Number*
Please enter a valid phone number.
Business Phone Number
Please enter a valid phone number.
May we contact you at work?*

YesNo
Email Address*
example@example.com
Position Applying For*
Date Available*

MonthDayYear
Date
Are you interested in (Check all that apply)*

Full timePart timeTemporarySummer

Days and hours available. Complete if applying for any position.*

	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
From
To

Are you 18 years or older? (No one under age 16 may be hired)*

YesNo
Desired Salary*
How were you referred to us?
EDUCATION

Tell us about your Education. Type N/A if not available.*

	Name School	Address	City	State	Degree/Area of Study	# of Years Attended	Graduated? (Yes or No)
High School
College
Graduate School
Other

U.S. Military Service
Branch of Service*
Type N/A if not applicable
Technical Specialization*
Type N/A if not applicable
Rank Attained*
Type N/A if not applicable
LEGAL
Are you legally authorized to work in the United States? (Identity and employment eligibility of all new hires will be verified as required by the Immigration Reform and Control Acts of 1986)*

YesNo
Were you ever discharged by any company?*

YesNo
If yes, give name of company(ies)*
Type N/A if not applicable
Reason for discharge*
Type N/A if not applicable
Have you ever been convicted of or pleaded guilty to (including a plea of nolo contendere) a misdemeanor?*

YesNo
If yes, please explain in full: at any time within the past 5 years?*
Type N/A if not applicable
Have you been convicted of or plead guilty to (including a plea of nolo contendere) a felony? (you are not obligated)*

YesNo
If yes, please explain to disclose sealed, erased or expunged records of conviction(s) or records of arrests or criminal charges which did not result in offense and final disposition: a conviction?*
A conviction will not necessarily disqualify an applicant from employment. Type N/A if not applicable
EMPLOYMENT HISTORY
List employment starting with your most recent position. You may include a description of verified work performed on a volunteer basis.
Is any additional information relative to a different name necessary to check your work record?*

YesNo
If yes, explain.*
Type N/A if not applicable
List of Employers and Information
Duration of Employment: Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Job Title
Name of Supervisor
Salary or Wages: Starting Wage - Final Wage
Example: $5,000 - $7,000
Reason For Leaving
Duration of Employment: Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Job Title
Name of Supervisor
Salary or Wages: Starting Wage - Final Wage
Example: $5,000 - $7,000
Reason For Leaving
Duration of Employment: Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Job Title
Name of Supervisor
Salary or Wages: Starting Wage - Final Wage
Example: $5,000 - $7,000
Reason For Leaving
Duration of Employment: Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Job Title
Name of Supervisor
Salary or Wages: Starting Wage - Final Wage
Example: $5,000 - $7,000
Reason For Leaving
Duration of Employment: Start Date

MonthDayYear
Date
Duration of Employment: Start Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Job Title
Name of Supervisor
Salary or Wages: Starting Wage - Final Wage
Example: $5,000 - $7,000
Reason For Leaving
Have you previously worked for Rockin J Feed & Tack or any of its subsidiaries or Franchisees?

YesNo
If yes, enter the name of the company
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position Held
Supervisor
Dates Employed From

MonthDayYear
Date
Dates Employed To

MonthDayYear
Date
Reason for Leaving
REFERENCES

Please do not list relatives.

Business References*

	Name	Address	Work Phone number	Title	Years known
Reference 1
Reference 2
Reference 3

PLEASE READ CAREFULLY
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I understand, also, that I am required to abide by all rules and regulations of Rockin J Feed & Tack. I understand and agree that if employed, employment will be "AT WILL." That is, either I or the employer may end the employment relationship at any time, for any reason, or for no reason. I understand that receipt of this application does not imply employment and that this application and/or any other documents are not contracts of employment.
APPLICANTS SIGNATURE

Clear
Date

MonthDayYear
Date
Should be Empty:

EMPLOYMENT APPLICATION

PERSONAL INFORMATION

EDUCATION

U.S. Military Service

LEGAL

EMPLOYMENT HISTORY

REFERENCES

PLEASE READ CAREFULLY