Application For Employment - Payless Markets

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APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
Last Name
First
Middle
Social Security No.
AKA: Also Known As (Legally Changed)
Home Phone
Street Address
Work Phone
Mailing Address
Other Contact
Position Applying For (Please specify don't leave open)
Staring Salary Desired
Date You Can Start
Do You have any Physical Condition which may prevent you from performing the essential functions of the job you are applying for ?
Are you 18 years of age or older ? ( ) Yes ( ) No
( ) Yes
( ) No
Are you available for full-time work? If not, give hours of availability. ( ) Yes
( ) No
Have you ever worked here before? If yes, Where and When? ( ) Yes
( ) No
Are you eligible to work in the United States ?
If you posses a Lawful Alien Permanent resident Card, please give card number
( ) Yes
( ) No
Have you ever been Charged, Arrested or Convicted of any crime ? ( ) NO ( ) YES If Yes, Please explain.
(Arrest, Charge or Convicted will not necessarily disqualify an applicant to employment.)
Who Referred you to us?
( ) Agency
( ) Ad
( ) Employee
( ) Other
SPECIAL TRAINING, EXPERIENCE OR SKILLS
DATE OF ATTENDANCE
List any special Training, Experience or skills (language, typing, O-J-T., computer, etc..)
EMPLOYMENT HISTORY
Please provide all information asked, inclusive when a resume is attached. Employment will be verified.
(List most recent employment first. )
Company Name
Telephone
Address
Employed (State Month and Year)
From
To
Hourly or Monthly Pay
Start
Last
Name of Supervisor
Reason(s) for Leaving
State Job Title and Describe your work
Company Name
Telephone
Address
Employed (State Month and Year)
From
To
Hourly or Monthly Pay
Start
Last
Name of Supervisor
Reason(s) for Leaving
State Job Title and Describe your work
Company Name
Telephone
Address
Employed (State Month and Year)
From
To
Hourly or Monthly Pay
Start
Last
Name of Supervisor
Reason(s) for Leaving
State Job Title and Describe your work
If you need additional space, please attach a separate sheet.
(COMPLETE REVERSE SIDE)

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