APPLICATION FOR EMPLOYMENT
APPLICATION FOR EMPLOYMENT
It is the policy of Surplus Outlet to afford equal opportunity for employment. Federal, state, and local laws prohibit illegal discrimination in hiring or employment on the basis of race, color, creed, national origin, ancestry, religion, sex, affectional or sexual orientation, marital status, familial status, age, disability, veteran status, or any other protected category under state or federal equal opportunity laws. This application will be given every consideration, but its receipt does not imply that the applicant will be employed.
Please answer every question. Use INK and PLEASE PRINT.
_________
Date
_______________________________________ ______________________________
First Middle Last Social Security Number
_______________________________________ ______________________________
Address: Telephone Number
_______________________________________ ______________________________
City State Zip Code Secondary Telephone Number
List type(s) of work desired: ________________ Salary Requirements: ____________
Date available for work: ___________________ Location Desired: _______________
Employment Desired: Full-Time:_____ Part-Time:_____ Temporary: _____
Are you willing to work: Day Shift: _____ Night Shift:____ Weekends/ Holidays:____
Availability: Hours from ________ to _________
Hours Comments: ________________________________________________________
_______________________________________________________________________
Have you applied for a position with Surplus Outlet? ____Yes ____No
If yes, give approximate date: _______________
APPLICATION FOR EMPLOYMENT
Are you a former employee of Surplus Outlet? ____Yes ____No
If yes, give dates from ____________ to ____________
Reason for leaving: _______________________________________________________
Are you related to anyone currently employed by Surplus Outlet? ____Yes ____No
If yes, please list their name(s): ______________________________________________
Have you ever pleaded guilty to or been convicted of any crime involving dishonesty or breach of trust? ____Yes ____No
If yes, give details of offense: _______________________________________________
_______________________________________________________________________
Have you ever pleaded guilty to any crime other than a misdemeanor or summary offense? ____Yes ____No
If yes, give details of offense: _______________________________________________
_______________________________________________________________________
I understand that I must be legally authorized to work in the United States and the state in which I am applying (i.e., meet employment eligibility requirements under the Immigration Reform and Control Act of 1986; meet applicable minimum age requirements, etc.). I understand that I will be required to submit sufficient documentation or take certain steps to comply with these laws. ____Yes ____No
PROFESSIONAL REFERENCES:
Please provide the names and addresses of two persons NOT RELATED to you other than your immediate supervisor, to whom we can refer.
________________________________________________________________________
Name Street City State Zip Code
___________________ ________________________ __________________
Phone Number Occupation Years Known
APPLICATION FOR EMPLOYMENT
________________________________________________________________________
Name Street City State Zip Code
___________________ ________________________ __________________
Phone Number Occupation Years Known
Employment Record:
Starting with PRESENT or MOST RECENT, list all previous employers, regardless of length of employment. Include self-employment, summer and part-time jobs. Do not skip any jobs. If you need more space, please continue on a separate sheet. This information must be fully completed. Please do not indicate, “Please see resume”. A material misstatement or omission of fact is the basis for immediate termination and for refusing employment.
________________________ __________________________________________
Name of Employer Address City State Zip Code
From: To:__________ ____________________ __________________
Date of Employment Ending Salary Supervisor’s Name
Position and Duties: _________________________ _______________________
Supervisor’s Phone Number
Reason for Leaving: _______________________________________________________
May we contact employer? ____Yes ____No
If no, please explain: ______________________________________________________
________________________ __________________________________________
Name of Employer Address City State Zip Code
From: To:__________ ____________________ __________________
Date of Employment Ending Salary Supervisor’s Name
Position and Duties: _________________________ _______________________
Supervisor’s Phone Number
Reason for Leaving: _______________________________________________________
May we contact employer? ____Yes ____No
If no, please explain: ______________________________________________________
APPLICATION FOR EMPLOYMENT
________________________ __________________________________________
Name of Employer Address City State Zip Code
From: To:__________ ____________________ __________________
Date of Employment Ending Salary Supervisor’s Name
Position and Duties: _________________________ _______________________
Supervisor’s Phone Number
Reason for Leaving: _______________________________________________________
May we contact employer? ____Yes ____No
If no, please explain: ______________________________________________________
________________________ __________________________________________
Name of Employer Address City State Zip Code
From: To:__________ ____________________ __________________
Date of Employment Ending Salary Supervisor’s Name
Position and Duties: _________________________ _______________________
Supervisor’s Phone Number
Reason for Leaving: _______________________________________________________
May we contact employer? ____Yes ____No
If no, please explain: ______________________________________________________
If presently employed, why do you desire to change your position?__________________
________________________________________________________________________
Have you ever been discharged for cause or asked to resign? ____Yes ____No
If yes, please explain: ______________________________________________________
________________________________________________________________________
APPLICATION FOR EMPLOYMENT
Education:
|Type |School Name |Address |# of Years of |Courses of Study |Diploma/ Degree |
| | | |Attended | | |
|High School | | | | | |
|Business or Technical School | | | | | |
|College or University | | | | | |
|Other Training | | | | | |
What types of relevant equipment are you familiar with? __________________________
Agreement and Release:
PLEASE READ THE FOLLOWING PARAGRAPHS BEFORE YOU SIGN THIS APPLICATION, BECAUSE YOUR SIGNATURE CONSTITUTES YOUR AGREEMENT THERETO IN RETURN FOR THE CONSIDERATION OF YOUR APPLICATION.
I authorize Surplus Outlet and any employees or agents thereof, to make whatever inquiries it deems necessary of any person, educational institution or organization to verify any of the information given in my application for employment and to determine my qualifications and abilities. In filing this application, I declare that my answers are true and complete. I understand that I will be dismissed if, after employment, it is learned that any of my answers on this application, or any supplement thereto, or in any pre-employment interview, were false or incomplete.
I authorize Surplus Outlet, and any employees or agents thereof, to investigate and verify any of the information given in my application for employment, including my prior employment, my educational background and my qualifications. I also authorize and request every school official, law enforcement official, governmental official, court official, and every other person, corporation, association, organization, institution, or entity having control of any document record, or other information, including personal opinion or belief, pertaining to me or to my application for employment, to furnish the originals or copies of any documents, records or other information to Surplus Outlet, or to any representative acting on Surplus Outlet’s behalf, to inspect and make copies of any such documents, records or other information. I am willing that a copy of this document be accepted with the same authority as the original.
I hereby release and hold harmless Surplus Outlet and all persons or companies supplying such information from all liability and responsibility in connection with the furnishing of that information. I release and hold Surplus Outlet harmless from and against any and all liability or claims for damages that may result from this investigation, or the release, disclosure and use of this information.”
APPLICATION FOR EMPLOYMENT
If I am accepted as an employee, I agree to obey all rules, regulations and policies of Surplus Outlet.
I understand that if I am employed by Surplus Outlet my employment will be at-will. I understand and agree that I have the right to terminate my employment at any time with or without cause and that Surplus Outlet retains a similar right.
I understand and accept that business needs may make the following conditions mandatory: overtime, shift work, a rotating work schedule, or a work schedule that includes Saturday and Sunday.
I hereby acknowledge that I have read the above statement and understand the same.
_______________________________________________ ____________________________
Signature Date
*Please attach a copy of your resume with your application.
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