Employment Application
Name
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Are you 18 or older?
Yes
No
Are you 16 or older?
Yes
No
Did you learn about this position through an online posting?
Yes
No
What position are you applying for?
Team Member
Shift Leader
How many hours are you available to work per week?
Please indicate the times you are available to work by typing an X in the time slots you would be available.
*
7am-9am
9am-11am
11am-1pm
1pm-3pm
3pm-5pm
5pm-7pm
7pm-9pm
9pm-10:30pm
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please include your past 5 years of work history.
*
High School/GED Name
Other Training (college, vocational, technical, graduate)
Please indicate any professional licenses or certifications that you hold:
Military Service:
Yes
No
If yes, branch/specialized training
List any two non-relatives and phone numbers who would be willing to provide a reference for you.
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I, the applicant undersigned, agree with the following statements:
I declare that all information provided in this form is true and complete.
I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered later.
IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. I UNDERSTAND MY EMPLOYMENT IS TENTATIVE BASED UPON A SUCCESSFUL COMPLETION OF A 10 YEAR CRIMINAL BACKGROUND CHECK.
I acknowledge that I meet all required qualifications for this position and am able to perform the job responsibilities outlined in the job posting.
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