Application For Employment - Payless Markets Page 2
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1
2EMPLOYMENT HISTORY
(List most recent employment first. ) Please provide all information asked, inclusive when a resume is attached. Employment will be verified.
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
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
EDUCATION
No. of Years
Did you
DEGREE OR
COURSE
SCHOOL
NAME AND LOCATION
OF STUDY
Completed
Graduate
DIPLOMA
( ) YES
HIGH SCHOOL
( ) NO
( ) YES
COLLEGE
( ) NO
( ) YES
OTHER
( ) NO
APPLICANT'S CERTIFICATION & AGREEMENT
I hereby declare the information provided by me in this Application for Employment is true, correct and complete to
the best of my knowledge I understand that if employed, any misstatement or omission of fact on this application shall be
considered cause for dismissal. I also authorize the companies, school or persons named above to give an information
relevant to my bonafide employment qualifications. I hereby release said companies, schools or persons from all liability
for any issuing this information.
I understand that employment at this company is "at will" which means that either I or the company can
terminate the employment relationship at any time, with or without prior notice and for any reason not
prohibited by federal or territorial laws. All employment is continued on that basis. I understand that no
supervisor, manager or executive of the company, has any authority to alter the foregoing.
SIGNATURE
DATE
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