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.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download