JAMIN’ LEATHER
APPLICATION FOR EMPLOYMENT
(An equal
opportunity employer application.doc 7/12/07)
Name: __________________________ _______________________________ _________ Date: ___/___/___
LAST
FIRST MI
Address:
___________________________________________________________________________________
City, State, Zip:
_____________________________________________________________________________
Permanent Address: _________________________________________________________________________
Day Phone: (___)____-______ Evening Phone: (___)____-______
Social Security Number: _________________
E-MAIL address:
____________________________________________________________________________
Are you 18
years or older? r YES r NO (if no, DOB ___/___/___ Age:____)
Position Applied For: ______________________________ Salary
Desired: $_________ Hours Desired: _______
r Permanent
full time r Temporary
full time r Permanent
part time r Temporary part time
When can start work? r Immediately r Other (explain):
____________________________________
If hired, how long do you intend to remain at this job?
_______________________________________________
Availability: r Flexible
(any) r Times
Unavailable: _________________________________________________
How did you learn about us to apply?
____________________________________________________________
Why do you want to work here?
________________________________________________________________
__________________________________________________________________________________________
What is your impression of a good job?
__________________________________________________________
__________________________________________________________________________________________
What computer programs do you know extremely well? r none r I don’t
work with computers
__________________________________________________________________________________________
What is your future plans:
_____________________________________________________________________
__________________________________________________________________________________________
Do you have any obligations which limits your availability
to work? r NO r YES (explain): __________
Are you active in any civic, military or athletic
organizations? r NO r YES
(explain): __________
Do you take any regular medications that we should be made
aware of? r NO r YES (explain): __________
Are you willing to submit to a drug test: r NO r YES (explain): __________
Do you have any physical limitations of which we should be
aware? r NO r YES (explain): __________
Have you been charged with a crime within the past 7
years? r NO r YES (explain): __________
Do you have any objections of us doing a background check on
you? r NO r YES (explain): __________
(Convictions
will not necessarily disqualify an applicant from employment)
High school: ________________________________ Location:
____________________ Grades: _______
Did You
Graduate? r YES r NO If not, explain:
____________________________________________
College: __________________________________ ______ Location:
_____________________ # Years: ____
Subjects
studied: ____________________________________________________________________
Did You
Graduate? r YES r NO If
not, explain: ___________________________________________
Trade school: _____________________________________
Location: ____________________ # Years: ____
Subjects
studied: ____________________________________________________________________
Did You
Graduate? r YES r NO If
not, explain: ___________________________________________
IN CASE OF EMERGENCY NOTIFY:
____________________
__________________
_______________________________ (____)_____-______
Name Relationship Address
Phone
FORMER EMPLOYERS (last one first)
May we inquire with your present or most recent
employer? r YES r NO If not, why?_____________________
Company: _____________________________________
Manager/Supervisor: ___________________________
Location (city, state):
___________________________________________________ Phone: (____)____-______
Dates from: ____/____ to: ____/____ Your Position:
______________________________Salary: ____________
Job duties:
_________________________________________________________________________________
Reason for leaving:
__________________________________________________________________________
Company: _____________________________________ Manager/Supervisor:
___________________________
Location (city, state):
___________________________________________________ Phone: (____)____-______
Dates from: ____/____ to: ____/____ Your Position:
______________________________Salary: ____________
Job duties:
_________________________________________________________________________________
Reason for leaving:
__________________________________________________________________________
Company: _____________________________________
Manager/Supervisor: ___________________________
Location (city, state):
___________________________________________________ Phone: (____)____-______
Dates from: ____/____ to: ____/____ Your Position:
______________________________Salary: ____________
Job duties: _________________________________________________________________________________
Reason for leaving:
__________________________________________________________________________
Company: _____________________________________
Manager/Supervisor: ___________________________
Location (city, state):
___________________________________________________ Phone: (____)____-______
Dates from: ____/____ to: ____/____ Your Position:
______________________________Salary: ____________
Job duties: _________________________________________________________________________________
Reason for leaving:
__________________________________________________________________________
Which one of these jobs did you like the best?
_____________________ Why? __________________________
__________________________________________________________________________________________
Are there any jobs, related or not, that you did not include
with ones listed? r NO r YES
(explain): __________
__________________________________________________________________________________________
List any skills that my help you here at Jamin’ Leather:
______________________________________________
__________________________________________________________________________________________
Additional information you feel may be helpful to us in
considering your application: ________________________
__________________________________________________________________________________________
REFERENCES (3
Unrelated persons whom you have known at least one year)
Name: ___________________________ City, State:
____________________________ Job: _______________
Years
acquainted: ______ How acquainted: _____________________________ Phone:
(___)____-____
Name: ___________________________ City, State:
____________________________ Job: _______________
Years
acquainted: ______ How acquainted: _____________________________ Phone:
(___)____-____
Name: ___________________________ City, State:
____________________________ Job: _______________
Years
acquainted: ______ How acquainted: _____________________________ Phone:
(___)____-____
Are you acquainted with anyone that had or does work
here? r NO r YES If so,
who?________________
I certify that the facts contained in this application are
true to the best of my knowledge. I
authorize investigation of all statements contained here as may be necessary in
arriving at an employment decision. I
understand that, if employed, falsified statements on this application shall be
grounds for dismissal.
OFFICIAL USE:
Onsite Greeting By: ________________ (attach comments only)
Interview: By: ____________________ Time: ___:___ Date: ____/____/____