Smoke Head Shop & Vape Employment Application

Employment Application

Juicy-est Juice LLC

We are an equal opportunity employer. Applicants will be considered regardless of race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status. Equal access to the hiring process, services, and employment is available to all individuals. Applicants requiring accommodations to the application and/or interview process should contact the Human Resource Representative.

Each question should be answered completely and accurately.

No action will be taken on this application until all questions have been answered and the application has been signed and dated. Verification of eligibility to work in the U.S. will be required if an employment offer is made.

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Is it ok to text you at this number for an interview?*

YESNO

Date of Birth *

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Confirmation Email

Position(s) applying for*

Wage expectations*

How did you hear about this job

Are you fluent in a foreign language?*

YESNO

If yes, what language(s)?*

Are you over the age of 18?*

YESNO

Are you eligible to work in the United States?*

YESNO

Do you know anyone who works here, or has worked in the past?*

YESNO

If so, who*

Are you currently employed?*

YESNO

If so, where?*

Can you pass a backgroung check?*

YESNO

Can you pass a drug test?*

YESNO

Date available for work*

MonthDayYear

Are you available to work?*

Full timePart timeShift workTemporary

Are you able to work any necessary hours between 7:00 a.m. and 11:59 p.m. Sunday through Saturday?*

YESNO

If not, what days and hours are you NOT AVAILABLE?

Have you applied or worked here before?*

YESNO

Do you have your own dependable transportation?*

YESNO

Are you willing to work at any location in the City of Lubbock?*

YESNO

Have you been convicted of a felony/misdemeanor (other than traffic violations)?*

YESNO

If so, provide the location, date and result/outcome for each conviction:*

EDUCATION

Highest level of education completed:*

Please complete the appropriate sections

	Name & Location of School	Number of Years Attended	Did You Graduate?	Degree or Certification
GED / High School
Trade School
College
Graduate

WORK HISTORY

Please list your four most recent employers, list the most recent first

1. Employer

Employer's Name (Most current)*

Address & location of business*

Your title*

May we contact this employer?*

YESNO

If no, why?*

First and Last Name

Supervisor's name*

First and Last Name

Phone number*

Area CodePhone Number

Start date*

MonthDayYear

End date

MonthDayYear

Wages START:*

Salary or Hourly*

Wages END:*

Salary or Hourly*

Work performed:*

Reason for leaving*

2. Employer

Employer's Name (Second most recent)*

Address & location of business*

Your title*

May we contact this employer?*

YESNO

If no, Why?*

First and Last Name

Supervisor's name*

First and Last Name

Phone number*

Area CodePhone Number

Start date*

MonthDayYear

End date

MonthDayYear

Wages START:*

Salary or Hourly*

Wages END:*

Salary or Hourly*

Work performed:*

Reason for leaving*

3. Employer

Employer's Name (Third most recent)

Address & location of business

Your title

May we contact this employer?

YESNO

If no, Why?

First and Last Name

Supervisor's name

First and Last Name

Phone number

Area CodePhone Number

Start date

MonthDayYear

End date

MonthDayYear

Wages START:

Salary or Hourly

Wages END:

Salary or Hourly

Work performed:

Reason for leaving

4. Employer

Employer's Name (Fourth most recent)

Address & location of business

Your title

May we contact this employer?

YESNO

Supervisor's name

First and Last Name

Phone number

Area CodePhone Number

Start date

MonthDayYear

End date

MonthDayYear

Wages START:

Salary or Hourly

Wages END:

Salary or Hourly

Work performed:

Reason for leaving

ADDITIONAL INFORMATION

Do you have a U.S. military service record?*

YESNO

If yes, branch of service*

List job-related accomplishments, projects, and awards. (Exclude information that would reveal race, color, national origin, religion, gender, age, marital, or veteran status; medical condition, disability; or any other legally protected status.)

Why should you be considered for a position at Smoke Head Shop & Vape?*

Do you know anyone who works or has worked for this Company. If so, who?

REFERENCES

List three professional references, (business or work, not relatives) that you have known for at least one year. List at least one previous supervisor.

1. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Area CodePhone Number

Years acquainted*

REFERENCES

List three professional references, (business or work, not relatives) that you have known for at least one year. List at least one previous supervisor.

Relationship*

2. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Area CodePhone Number

Years acquainted*

Relationship*

3. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Area CodePhone Number

Years acquainted*

Relationship*

SOCIAL MEDIA

Please list the names of your social media

FaceBook*

Instagram*

Twitter*

Other name of social media & your name*

AUTHORIZATION

I understand that Juicy Juice and Smoke Head Shop are making no employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination, if employed.

I authorize Smoke Head Shop & Vape LLC to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job-related. I give my full consent for all contacted individuals, including former employers, to provide information concerning this application, and I waive my right to bring any cause of action against these individuals for any and all liability for damages arising from furnishing the requested information to Smoke Head Shop & Vape LLC. I acknowledge that a facsimile and/or photocopy of this form is as valid as the original.

Pre-employment testing may be required (drug testing, background checks, physical examinations, motor vehicle checks). Testing may be applicant or employer-paid based on the employer.I understand that any offer of employment may be withdrawn if drug tests are positive and/or if a condition is discovered for which no reasonable accommodation can be made.

I understand that this application is current for 60 days. At the conclusion of this time, if I have not heard from Smoke Head Shop & Vape LLC and still wish to be considered for employment, it will be necessary to complete a new application.

I understand that if hired, employment is at-will, regardless of the employer, and may be terminated by myself, the employer or Smoke Head Shop & Vape LLC at any time, with or without cause or notice, for any reason or no reason.

By entering your name, you agree to accept the terms of the above document with an electronic signature.*

I agreeI do not agree

You must agree to accept the terms of the document in order to submit an application.

Date*

MonthDayYear

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