Employment Application
123 Rt 50 Glenville, NY in Socha Plaza
Full Name
*
First Name
Middle Initial
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
E-mail
*
example@example.com
Home Phone Number
-
Area Code
Phone Number
Cell Phone Number
-
Area Code
Phone Number
Available start date:
*
-
Month
-
Day
Year
Date
Are you authorized to work and remain in the United States?
*
Yes
No
Have you ever been convicted of any violation of the law? (Exclude traffic violations) A conviction will not necessarily disqualify an applicant from the position sought.
*
Yes
No
If Yes, Explain:
Please fill in times you can work for each day
*
Earliest.....
Latest.....
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Position Apply For
*
Anything available
Counter Person / Sandwich Maker
Baker Only
Baker and Sandwich Maker / Counter Person
Assistant Manager
Manager
Desired Pay Rate Per Hour
*
Employment Desired (you may choose more than 1 answer)
*
Full Time
Part Time
Full or Part Time
Anything Available
Education:
Are you a High School Graduate?
*
Yes
No
High School Equivalency?
*
Yes
No
Are you presently attending school?
*
Yes
No
Type of Education
High School
College or University
Vocational or Special Training
Graduate School
Any Additional Education you would like to tell us about?
Employment History
Beginning with your present or most recent experience, an additional sheet or resume may be attached, but cannot be substituted for a completed application. Include military service if applicable.
Name of Employer:
*
Job Title:
*
Address:
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor:
What was your starting Hourly Pay Rate?
optional
What was your most recent Hourly Pay Rate?
optional
Date started
-
Month
-
Day
Year
Date Picker Icon
Date ended
-
Month
-
Day
Year
Date Picker Icon
Reason for Leaving:
*
Description of Duties:
*
Name of Employer:
*
Job Title:
*
Address:
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Supervisor:
What was your Hourly Pay Rate?
*
Date started
-
Month
-
Day
Year
Date Picker Icon
Date ended
-
Month
-
Day
Year
Date Picker Icon
Reason for Leaving:
*
Description of Duties:
*
Do you have additional employers to enter?
*
Yes
No
Have you ever worked in a FOOD Service related Job?
*
Yes
No
Please list your FOOD Service related jobs and what years you worked at each of these jobs.
May we contact your present employer?
*
Yes
No
May we contact your former employers?
*
Yes
No
Personal References
Full Name
First Name
Last Name
How do you know this person?
How long have you know this person?
Phone Number
-
Area Code
Phone Number
Full Name
First Name
Last Name
How do you know this person?
How long have you know this person?
Phone Number
-
Area Code
Phone Number
Upload Resume (Optional)
Upload a Self Image (Optional)
Upload a Self Image (Optional)
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform