Fischer's Hardware Employment Application - Baytown

Employment Application - Baytown

We greatly appreciate your interest in our organization and assure you that applicants are considered for all positions without regard to race, color, sex, age, religion, national origin, disability, marital, or veteran status. Please note this application must be completed in its entirety and signed, in order to be considered for employment. Information submitted on this application is subject to verification. NOTE: All new hires are required to submit documentation in accordance with the Immigration Reform and Control Act of 1986.
Personal Information
Name*

First NameLast Name
Social Security Number*
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at this address?
Are you at least 18 years of age?

YesNo
If No, please state your age:
Are you legally eligible for employment in the US?

YesNo
Email*
example@example.com
Employment Information
Position applying for:*
Date available to start:*

MonthDayYear
Date
Referred by:
Type of employment desired:

Full timePart timeTemporary
Wage Desired: $ per
Are there any shifts or hours that you cannot work?

YesNo
If yes, please identify:
Are you able and willing to perform job related functions with or without reasonable accommodation?

YesNo
Have you ever applied for a position with this Company before?

YesNo
If yes, When?
Are you presently employed?

YesNo
If yes, may we contact your present employer?

YesNo
In the event of an Emergency, Notify: Relationship Name Street Address Phone Number
Education

	Years Completed	Graduated(Yes or No)	Degree earned (Major)
High School
College/University
Graduate School
Trade, Business, or Correspondence School

List any extracurricular activities, awards, scholarships, or clubs that you were involved in which might be related to the position for which you are applying:
Employment Experience

Please give accurate and complete full/part time employment record. Start with your present or most recent employer first.
Company Name:
Telephone:
Address:
Name of Supervisor
Employed From:

MonthDayYear
Date
Employed To:

MonthDayYear
Date
State job title and responsibilities:
Reason for separation:
Salary/Wages: Start Finish
Company Name:
Telephone:
Address:
Name of Supervisor
Employed From:

MonthDayYear
Date
Employed To:

MonthDayYear
Date
State job title and responsibilities:
Reason for separation:
Salary/Wages: Start Finish
Company Name:
Telephone:
Address:
Name of Supervisor
Employed From:

MonthDayYear
Date
Employed To:

MonthDayYear
Date
State job title and responsibilities:
Reason for separation:
Salary/Wages: Start Finish
Company Name:
Telephone:
Address:
Name of Supervisor
Employed From:

MonthDayYear
Date
Employed To:

MonthDayYear
Date
State job title and responsibilities:
Reason for separation:
Salary/Wages: Start Finish
Note that all the employers listed above will be contacted unless the applicant indicates differently.
Are there any employers above whom you do not wish for us to contact?

YesNo
If yes, please indicate employer and reason:
References

	Name	Address	Phone Number	Years Acquianted	Years Known
1
2
3

I hereby reaffirm that I have read the foregoing questions and that my answers to them are true and correct and that I have not misrepresented or withheld any information. I understand that falsification of this information may be cause for immediate dismissal. I further acknowledge that my employment may be terminated, and the company or I may withdraw any offer of employment without prior notice. I also understand that my employment is at will. This means I am free to terminate my employment at any time, for any reason, and the company retains the same right. I understand that any offer of employment may be contingent upon a credit and criminal background investigation and a pre-employment drug screen. I hereby authorize all references and former employers listed on my employment application to give the company any and all information concerning my previous employment and any pertinent information they might have, personal or otherwise. I hereby release all parties, including agents, from any claims, causes of action, or liability from damages that may or could result from furnishing such information to the company or as a result of information obtained through a background investigation or drug screen.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: