APPLICATION FOR EMPLOYMENT

Date*

Date

Name*

First NameMiddle NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone No.*

Format: (000) 000-0000.

Applicant's Email Address*

example@example.com

Referred By:

If this was a referral

Store Location Desired*

Position

Date You Can Start

Date

Desired Salary

YesNo

FULL – TIMEPART – TIMESEASONAL

Name

Location

YesNo

Date of Graduation

Date

Subjects Studied and Degree(s) Received

Name

Location

Years Attended

YesNo

Subjects Studied and Degree(s) Received

Name

Location

Years Attended

YesNo

Subjects Studied and Degree(s) Received

SPECIAL TRAINING

SPECIAL TRAINING - Line 2

ACTIVITIES & INTERESTS

(EXCLUDE ORGANIZATIONS, THE NAME OR CHARACTER OF WHICH INDICATES THE RACE, CREED, SEX, MARITAL STATUS, AGE COLOR OR NATINOAL ORIGIN OF ITS MEMBERS)

ACTIVITIES & INTERESTS - Line 2

YesNo

NAME

Previous Store Location

DATES: FROM

Date

DATES: TO

Date

YesNo

The Company reserves the right to contact the employers listed below without any further notification to you. The Company will contact your present employer only if you consent. Indicate if you were known by a different name at any of these places of employment. I authorize the Company and its representatives to contact my prior employers and all others (with the exception of my current employer if I have marked that I do not consent to the Company contacting my present employer) for the purpose of verification of the information I have supplied below, and release the Company from any liability resulting from the information released. I authorize employers, schools, and other persons named on this application to provide any information or transcripts requested. *

Type Your Initials

Company Name

From Date:

MM/YEAR

To Date:

MM/YEAR

Address

Street Address

Street Address Line 2

CityState

Zip Code

JOB TITLE & DESCRIPTION

SUPERVISOR

PHONE

Format: (000) 000-0000.

REASON FOR LEAVING

NAME WHEN EMPLOYED

Company Name

From Date:

MM/YEAR

To Date:

MM/YEAR

Address

Street Address

Street Address Line 2

CityState

Zip Code

JOB TITLE & DESCRIPTION

SUPERVISOR

PHONE

Format: (000) 000-0000.

REASON FOR LEAVING

NAME WHEN EMPLOYED

Company Name

From Date:

MM/YEAR

To Date:

MM/YEAR

Address

Street Address

Street Address Line 2

CityState

Zip Code

JOB TITLE & DESCRIPTION

SUPERVISOR

PHONE

Format: (000) 000-0000.

REASON FOR LEAVING

NAME WHEN EMPLOYED

I certify, to the best of my knowledge, that the information submitted is complete and correct. I understand that if employed, the Company may terminate my employment (regardless of my length of employment) if I have made any false statements or misrepresentations in this application or during the interview process.

I understand that this application is not an offer of employment.

I understand that employment with the Company is contingent upon investigation of my previous employment record, references and other matters without any further notification to me. I authorize such an investigation and release my current and prior employers, references, and the Company from all liability in connection with such an investigation. I understand and agree that if, in the opinion of the Company, the results of the investigation are unsatisfactory, that an offer of employment that has been made may be withdrawn or my employment with the Company may be terminated.

If employed, I agree to observe all Company policies and procedures. I understand that these policies and procedures may be changed at any time at the Company’s sole option.

If employed, I understand that my employment is at will. I understand that my employment and compensation can be terminated, with or without notice, and with or without cause, at any time, at the option of either the Company or myself. I understand that my compensation and benefits are subject to change at any time, with or without notice to me.

INITIAL IF YOU ARE APPLYING FOR EMPLOYMENT IN MARYLAND AND/OR YOU ARE A MARYLAND RESIDENT. UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A POLYGRAPH EXAMINATION OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

INITIAL IF YOU ARE APPLYING FOR EMPLOYMENT IN MASSACHUSETTS AND/OR YOU ARE A MASSACHUSETTS RESIDENT. IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.

I have read, understand and agree to the above statements.

SIGNATURE OF APPLICANT*

DATE*

Date

Hour MinutesAM/PM Option

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APPLICATION FOR EMPLOYMENT

EMPLOYMENT DESIRED

Education History

High School

College

Other Education

WORK EXPERIENCE

Current or Last Employer

2nd Previous Employer

3rd Previous Employer

IMPORTANT - READ BEFORE SIGNING