Employment Application POLKA DOTZ

Employment Application POLKA DOTZ

Applicant Information

Full Name: / DOB
Last / First / M.I.
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Phone: / () / E-mail Address:
Date Available: / Social Security No.: / Desired Salary: / $
Position Applied for:
Are you a citizen of the United States? / YES / NO / If no, are you authorized to work in the U.S.? / YES / NO
Have you ever worked for this company? / YES / NO / If yes, when?
Have you ever been convicted of a felony? / YES / NO
If yes, explain:
What is your availability?
Sunday / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday

Education

High School: / Address:
From: / To: / Did you graduate? / YES / NO / Degree:
College: / Address:
From: / To: / Did you graduate? / YES / NO / Degree:
Other: / Address:
From: / To: / Did you graduate? / YES / NO / Degree:

References

Please list three professional references.
Full Name: / Relationship:
Company: / Phone: / ()
Address:
Full Name: / Relationship:
Company: / Phone: / ()
Address:
Full Name: / Relationship:
Company: / Phone: / ()
Address:

Previous Employment

Company: / Phone: / ()
Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Company: / Phone: / ()
Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Company: / Phone: / ()
Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO

Military Service

Branch: / From: / To:
Rank at Discharge: / Type of Discharge:
If other than honorable, explain:
Are you currently employed? / YES / NO
Are you willing to work nights, weekends and holidays? / YES / NO
Please list any specialized skills, training, certifications including any foreign languages spoken fluently that you consider applicable for this job:
Have you ever been discharged from a job or asked to leave a position? If yes, please provide details:
Please Complete the following:
Describe your ideal job:
What motivates you?
Do you consider yourself successful? How do you define success?
How do you want to improve yourself within the next year?
If you are hired what are your expectations of our company?
If you are hired, what should we expect of your performance?
How long do you expect to work for us if hired?
Please check the answer that best describes you:
If you had enough money to retire, would you? / YES / NO
What kind of thinker are you? / Big Picture / Detail Oriented
What do you prefer? / Structured Organization / Minimal Supervision
What do you prefer? / Team Environment / Work Alone

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. I authorize to make such investigations and inquires of my personal, employment, educational, financial and other realated matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.
In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.
Signature: / Date: