APPLICATION FOR EMPLOYMENT


 

General Information:

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone

Have you ever been employed by us in the past?

No Yes

Location you were employed (ex. Breese, IL)... ?


Do you have any relatives currently working for the company?:

No Yes

If YES, please list their name and relationship to you ... ?


For what position are you applying:

Part Time Cashier  Full Time Cashier  Deli    Assistant/Manager

Are you willing to work: (Check all that apply)

Nights    Overtime  Weekends  Holidays

Indicate times you can work for the following days:

Monday: Tuesday: Wednesday: Thursday:

Friday: Saturday: Sunday:

Are you over 18 years of age?:

Yes No

If NO, state your age... ?


If you are not a U.S. Citizen, are you lawfully authorized to work in the United States?:

Yes No

Have you ever been bonded in prior employment?:

No Yes

If Yes, list names of employers... ?


Have you ever been convicted of a crime, pleaded guilty or "no contest" to a criminal charge, or entered into an agreement setting forth conditions for the eventual dismissal of a criminal case?:

No Yes

If Yes, explain the circumstances (date, place, etc.)... ?

 


Education History

High School:

Please check the number of years completed:

1 2 3 4

School attended: City: State:

High School Diploma or equivalent G.E.D.:

Yes No

College:

Please check the number of years completed:

1 2 3 4 5+

School attended: City: State:

Enter your Degree in the space provided below.


Enter your Major in the space provided below.



Work Experience

Name of Present or Last Employer:

Address Phone:

Position Held: Supervisor's Name:

Start Date: End Date: Starting Salary: Ending Salary:

Reason for leaving:


Name of Next Previous Employer:

Address: Phone:

Position Held: Supervisor's Name:

Start Date: End Date: Starting Salary: Ending Salary:

Reason for leaving:


Name of Next Previous Employer:

Address: Phone:

Position Held: Supervisor's Name:

Start Date: End Date: Starting Salary: Ending Salary:

Reason for leaving:


References

Please list 3 school, business or personal references. Do NOT list relatives:

    Name                                Address                                    Phone            Years Acquainted  

1.

School Work Personal

2.

School Work Personal

3.

School Work Personal


Employment/Application Statement

I hereby certify that I have a genuine interest in being hired and that all of the foregoing statements are true and correct. I understand that falsification of any of the information given herein, on any employment form or in any interview is grounds for immediate termination, regardless of when such falsification may be discovered.

I authorize this prospective employer to verify my statements and to undertake an investigation to gather and keep much employment and non-employment information as is permitted by law, and waive any legal requirement to provide notice to me regarding reports or records given or received in accordance with this authorization. Accordingly, all third parties [including but not limited to individuals, businesses and government bodies] are authorized to disclose any and all requested information to this perspective employer, and I agree to release all third parties, as well as this prospective employer and its employees, from any claims arising out of actions taken per these authorizations. Furthermore, I agree to reimburse this prospective employer and/or its employees for their attorney fees, costs and expenses in successfully defending any lawsuit I may assert in state or federal court based on actions connected with this Application for Employment  and/or the hiring process.

I understand that my employment may be terminated at any time, with or without cause, without liability to me for salary, wages, or other benefits except such as may been earned up to the date of termination of services.

If accepted for employment, I agree to comply with all company policies, procedures, rules and regulations made known to me at the time of employment or any other times thereafter, and to perform all duties assigned to me to the best of my ability.

I have read the 'Employment/Application Statement' - If so, type your name in the space:

 


Please select the MotoMart location you would like to send this application to: (Note, to select more than one location, hold the 'Ctrl' button down on your keyboard as you click your selections with the mouse. All selections will be highlighted in blue)

 

(Scroll through to see ALL locations)



Copyright © 2004 [FKG Oil/MotoMart]. All rights reserved.
Revised: 03/09/06