16 Workplace -- Application for Employment (print and WRITE the information)_1

16 Workplace -- Application for Employment (print and WRITE the information)_1

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Pitts' Grocery Store Sample Application for Employment PERSONAL INFORMATION Name Last First Middle Present Address Street City State Zip How Long Have You Lived at this Address? Primary Phone No. Secondary Phone No. EMPLOYMENT DESIRED Position Are You Employed Now? Yes ____ No ____ If So May We Inquire Of Your Present Employers? Ever Applied to this Company Before? Where? _____________ When? ________ SCHOOL Name of School Currently Enrolled ___________________________________ Current Grade Level _________ Are You At Least 18 Years Old? Yes ____ No ____ How Did You Hear of This Job Opening? Are You At Least 16 Years Old? Yes ____ No ____ Days Available For Work? _____________________________ Are You a Student? Yes ____ No _____ Times Available For Work? _____________________________ If Not A Student, Last Grade Completed: _______ Type Of Work Desired:
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Unformatted text preview: Full Time _____ Part Time ____ Position Desired: (Be Specific) Yes _____ No _______ If Yes Explain: WORK HISTORY AND/OR REFERENCES Name of Reference Company Name Address City/State/Zip Phone # / / / I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal Signature Date Date You Can Start Salary Desired ________ Have You Ever Been Convicted Of A Crime or Participated In Pre-Trial Intervention? (Minor Traffic Violations Excluded) Last Employer Or Reference #1 Next To Last Employer Or Reference #2 Second To Last Employer Or Reference #3 Date Started/ Date Left Salary/Rate Per Hour (if applicable) Reasons for Leaving (if applicable)...
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