Job Application - Employment Opportunities

Title: Janitorial – PT Monday through Friday

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Details

First Name *
Middle Name
Last Name *
Email Address *

Contact Details

Street Address
City
State
Zip Code
Telephone
Cell phone

About You

The best time to contact you
If you are under 18, and it is required, can you furnish a work permit?	Yes No
If no, please explain
Have you ever been employed here before?	Yes No
If yes, when?
Are you either a US citizen or alien authorized to work in the US? *	Yes No
Date available for work
Days & hours not available for work
*PLEASE NOTE: NIGHTS, WEEKENDS & HOLIDAYS ARE PART OF A RETAIL WORK SCHEDULE.*
Are you employed now?	Yes No
If yes, may we inquire of your present employer?	Yes No
If no, please explain
Type of employment desired *	Full-Time Part-Time
Have you been convicted of a felony? *	Yes No
If yes, please explain
*Conviction will NOT necessarily be a bar to employment. Each instance and explanation will be considered in relation to the position for which you are applying.*
What are your plans for the future?

Employment History

Provide the following information for your past three (3) employers, assignments or volunteer activities, starting with the most recent.
*Experience 1*
Employed From
To
Employer
Job Title
Telephone
Address
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
Reason for leaving
Starting pay per hour or year
Ending pay
*Experience 2*
Employed from
To
Employer
Job title
Telephone
Address
Immediate supervisor and title
Summarize the nature of work performed and job responsibilities
Reason for leaving
Starting pay per hour or year
Ending pay
*Experience 3*
Employed from
To
Emlpoyer
Job title
Telephone
Address
Immediate supervisor and title
Summarize the nature of work performed and job responsibilities
Reason for leaving
Starting pay per hour or year
Ending pay
Which of these jobs did yo like the best?
What did you like most about this job?
Why do you want to work at That Fish Place?

Skills and Qualificiations

Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying

Education

*High School*
Name & Location
Years completed
Did you graduate high-school?	Yes No
Course of study
*College*
Name & Location
Years completed
College major
College degree
Course of study
*Other Education*
Name & Location
Years completed
Did you graduate	Yes No
Course of study

References

Give the names of three persons not related to you, whom you have know at least one year.
*Reference 1*
Name
Address
Business
Telephone
Years known
*Reference 2*
Name
Address
Business
Telephone
Years known
*Reference 3*
Name
Address
Business
Telephone
Years known

Your Pets

Do you have any pets or aquariums?	Yes No
If so, please tell us about them. If you live at home you may include family pets.

Application Agreement

I understand that if I am employed, any misrepresentation of material omission made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from the employer’s service, whenever it is discovered I give the employer the right to contact and obtain information contained from all references, employers, education institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other person, corporations or organizations for furnishing information. The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law. This application is current for only 60 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as my be required by law. This application does not constitute an agreement or contract for employment for any specified period or define duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurance must be in writing and signed by an authorized officer. I understand it is the company’s policy not to refuse to hire a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA. I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.
I represent and warrant that I have read and fully undertand the foregoing and seek employment under these conditions. *	Yes No