Employment Application
Please take a moment to complete the following questions. Once submitted, a member of our team will be in touch with you soon. Thank you for your interest—we look forward to connecting with you!
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
Are you over the age of 18?
*
Yes
No
Are you either a U.S. citizen or an alien authorized to work in the U.S.?
*
Yes
No
Have you ever worked or attended school under another name? If so, under what name?
*
Do you have a Valid Drivers License?
*
Yes
No
Position Desired
Which position(s) are you interested in?
*
Sales
Warehouse
Retail Associate
Other
Date Available
*
Wage Desired?
*
Wage
*
Hourly
Monthly
Annually
Hours you are available to work:
*
Days of the week you are available to work
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How did you learn about this opening?
*
Have you worked for Everything Safety before?
*
Yes
No
Dates of previous employment with Everything Safety
*
Reason(s) for leaving:
*
Former supervisor(s) at this company:
*
Education
Education
*
High School
Technical School
College/University
Post-Graduate Education
Course of Study:
*
Other education, training, or special skills:
*
Skills
Typing speed (WPM):
*
Are you experienced in using personal computers?
*
Yes
No
PC
Mac
Are you able to use Microsoft Word or Excel?
*
Yes
No
What other programs are you capable of using?
*
Work Experience
Please provide details about your two most recent positions
Employer 1
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dates To/From
*
Position Held
*
Reason for leaving
*
Supervisor's Name & Title
*
May we contact Supervisor?
*
Yes
No
Supervisor Phone Number
*
Please enter a valid phone number.
Description of duties
*
Starting Compensation
*
Final Compensation
*
Employer 2
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dates To/From
*
Position Held
*
Reason for leaving
*
Supervisor's Name & Title
*
May we contact Supervisor?
*
Yes
No
Supervisor Phone Number
*
Please enter a valid phone number.
Description of duties
*
Starting Compensation
*
Final Compensation
*
Professional References
Please list three professional references who can speak to your work performance, reliability, and character. Do not include family members.
Reference 1
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years Known
*
Reference 2
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years Known
*
Reference 3
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years Known
*
Resume and Files
Upload a File
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Choose a file
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Authorization and Acknowledgements
I affirm that the information I have provided in this application is true to the best of my knowledge, information, and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure
Signature
Date
-
Month
-
Day
Year
Date
Submit Application
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