ONLINE EMPLOYMENT APPLICATION

 PERSONAL DATA

Your Full Name
(first, middle, last)
 
Street Address  
 City, State, Zip  ,
 Phone  
 Permanent Address
(if different than above)
 
 City, State, Zip  ,
 Permanent Phone
(if different than above)
 
Are You Under The age of 18?   If "Yes", type your age here -->
 Limitations: Do you have any physical or mental problems or disabilities which could limit you from satisfactorily performing this job?
.<--make selection here

If Yes, please describe them below:

 Convictions:

 Have you ever been convicted of a felony or retail-related crime (i.e., shoplifting?) Note: A "yes" response will not automatically disqualify you from employment.
. <--make selection here

If Yes, please describe them below:

 Citizenship:

If hired, can you supply proof that you are legally entitled to work in the United States? (Drivers License, Social Security Card, etc.)
.<--make selection here

 SCHEDULE / AVAILABILITY

In what type of employment are you most interested? .<--make selection

Which of our stores would you like to work in? 

What position would you like to apply for?

How many hours a week would you like to work?

 

 What, if any, are your salary/wage requirements?

 What is the first date you are available to work?
 What, if any, is the last date you are available to work?
 
Please list the days and times you will usually be available to work.
(type "any" if available all day)
SUN MON.
TUE WED.
THU FRI.
SAT  

Please enter any comments you may have about your schedule availability, outside time commitments, etc.

 

 

 EDUCATION


Please fill in all boxes that apply...

 School Type School Name School Location Area of Study  G.P.A. Last Year You've Completed Diploma or Degree Earned?
High School
College
Graduate
Other

Please type any special remarks about you may have about your education:

 

 SKILLS & INTERESTS

Please list special skills or interests you have that may relate to your employment:

 

 EMPLOYMENT HISTORY

Starting with your present or most recent employer,
please list all employers for whom you have worked, either part or full time.

YOUR MOST RECENT EMPLOYER
 Dates Employed  FROM: TO:
Employer's Name and Address
Supervisor's Name and Title
Your Position / Duties
 Your Pay Rate START: FINAL:
 Your Reason For Leaving

YOUR SECOND MOST RECENT EMPLOYER
 Dates Employed  FROM: TO:
Employer's Name and Address
Supervisor's Name and Title
Your Position / Duties
 Your Pay Rate START: FINAL:
 Your Reason For Leaving

YOUR THIRD MOST RECENT EMPLOYER
 Dates Employed  FROM: TO:
Employer's Name and Address
Supervisor's Name and Title
Your Position / Duties
 Your Pay Rate START: FINAL:
 Your Reason For Leaving

 

Have you had more jobs in addition to those shown above?

 . <--make selection here

 .
 If so, please provide a brief description

 

 REFERENCES

Please list names of three persons (other than relatives) we may contact
who have knowledge of your job related abilities.

  Name Telephone Address Occupation

1

2

3

 ADDITIONAL COMMENTS

Please enter any additional comments you may have regarding your application.

 REVIEW YOUR ENTRIES

Please take a moment to scroll up now and verify the
accuracy of your entries on this form.


Signify that your entries are correct
and that you agree to the terms you read
on the previous page
by typing your name in the box below

WOULD YOU LIKE A CONFIRMATION?

If you would like to receive an email confirmation
of our receipt of your application, please type your email
address in the box below. (optional)
NOTE: We will NOT share
your address with anyone else, or use your address for
any reason other than the confirmation notice.

SEND US YOUR APPLICATION

Once you have checked the accuracy of your entries
and given us an email address (if desired)
click the "SEND" button below to submit your application.

 

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