Employment Application Form

Application for Employment

The Dickson County Help Center & Thrift Store is a non-profit, public organization established to help those who find themselves in need due to an emergency situation.

All new employees are on probation for a period of 90 days. During that period, you will be monitored for proper appearance, attitude, punctuality, and job performance. Any false or misleading information given to secure the job will result in immediate termination.
Application Date

MonthDayYear
Date
Position Desired

CashierAssistance Office
Applicant Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone Number*
Emergency Contact*
Are you a citizen of the United States?*

YesNo
If not, do you have a legal right and proper documentation to work in the US?*

YesNo
Are you over the age of 18?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If yes, please explain:
Do you have a high school diploma or GED?*

YesNo
List any other education or special certifications you may have:
Are you able to perform the essential functions of the job for which you are applying?*

YesNo
If no, please explain:
Please describe any accommodations you will need that are not currently provided to adequately perform the essential functions of the position you are applying for:
How were you referred to us?*

Walk-InReferralFacebookLinkedInOther (please specify)
Prior Work History

List the following information of your current and previous employment beginning with the most recent first. Please explain any time span gaps between employment.
Resume (optional)

Cancelof
Current Employment*
Previous Employment
Previous Employment
Previous Employment
References

Please list two (3) references that are familiar with your work life.
Reference*
Reference*
Reference*
I hereby affirm that the information provided on this application and any accompanying resume is true and complete to the best of my knowledge. I also understand that falsified information or significant omissions may disqualify me and my application from further consideration for employment and may be considered justification for immediate dismissal if discovered at a later date.

I waive any right of privilege, privacy, and or confidentiality I may have in the information provided by references or others whom I have indicated may be contacted.
Signature*

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