Application For Employment
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1
2Application for Employment
Thanks for choosing Kansas Sampler/Rally House
Fill out this form in our store. (Unless submitting from our website)
Kansas Sampler has 7 locations in Kansas. Rally House has 5
locations in Missouri and Texas.
PLEASE PRINT
Position(s) Applied For ______________________________________________________________ Date of Application ______/______/______
Name __________________________________________________________________________________________________________________
Last
First
Middle
Address ________________________________________________________________________________________________________________
Street
City
State
Zip Code
Email address___________________________________________________________________________________________________________
Telephone (______) _________________________
Social Security Number ___________________________________________
If you are under 18, can you furnish a work permit? .......................................................................................................................... YES NO
Have you ever been employed here before? ....................................................................................................................................... YES NO
Are you legally eligible for employment in this country? .................................................................................................................. YES NO
(Proof of U.S. citizenship or immigration status will be required upon employment.)
Date available for work ...................................................................................................................................................................... ____/____/____
Full Time
Part-Tim
e Temporary
Seasonal
Educational Co-Op
Type of employment desired
Are you willing to submit to a background check, drug test and credit check? .................................................................................. YES NO
Did you fill this form in one of our stores? ......................................................................................................................................... YES NO
Have you been convicted of any crime in the last seven (7) years? ................................................................................................... YES NO
(Such conviction may be relevant if job related, but does not bar you from employment.)
If yes, please explain: _____________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Driver’s license number (if required by job) ___________________________________________
State ________________________________
Employment History
List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience.
From
To
Employer
Telephone
(
)
-
Job Title
Address
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
Reason for leaving
Hourly Rate/Salary
Start $________ per ________
Final $________ per ________
From
To
Employer
Telephone
(
)
-
Job Title
Address
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
Reason for leaving
Hourly Rate/Salary
Start $________ per ________
Final $________ per ________
From
To
Employer
Telephone
(
)
-
Job Title
Address
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
Reason for leaving
Hourly Rate/Salary
Start $________ per ________
Final $________ per ________
From
To
Employer
Telephone
(
)
-
Job Title
Address
Immediate Supervisor and Title
Summarize the nature of work performed and job responsibilities
Reason for leaving
Hourly Rate/Salary
Start $________ per ________
Final $________ per ________
An Equal Opportunity Employer
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Parent category: Legal