Name:
 

Social Security No:
 
 
How long have you lived at this address?


Phone Number:
 

Job Applied for:
 
 
Rate of pay expected $ per hour:

How did you hear of this opening?


How many hours a week would you like to work?

Have you worked for our company before?

If yes, When and Where?
  


How would you rate yourself?
(1 - Improvement needed)  (2 - OK)   (3 - Good)   (4 - Top Performer)

 Energy level: Your sense of urgency, self-motivation and enthusiasm.

 Communication Skills: Your ability to listen well, express ideas clearly and accept feedback.

 Hospitality: Your natural friendliness and customer service skills.

 Reliability: Your dependability, attendance, self discipline and dedication.

 Personal Pride: Your appearance, hygiene and achievement.

 Teamwork: Your cooperation with others and team spirit.

What achievements in life are you most proud of?


What are your personal strengths?


What are your weakest areas?

What are your five year goals?


Why do you want to work here?


Can you perform the essential functions of this job with
or without accommodations? Yes or No

In Case of Emergency, Contact:

Do you have transportation to work? Yes or No


If yes, state the relationship to you and location of employment



In the event you are required to use your personal or company
vehicle to conduct company business, please complete the following.

Do you have a valid drivers license? Yes or No

No If yes, indicate why:

Drivers license Number

Do you have automobile liability insurance? Yes or No

List below, beginning with your most recent, all present and past employment


PERSONAL REFERENCES (Not former employers or relatives)


Record of Education

BACKGROUND

 Are you 18 years of age or older? Yes No If No,

 Date of Birth

 Have you ever been convicted of a felony? Yes or No

 Have you ever been convicted of any crime involving violence to another person? Yes or No

  Have you ever been convicted of a crime involving dishonesty? Yes or No

 Have you ever been counseled or disciplined for cash handling violations? Yes or No


I certify that information given herein is true and complete to the best of my knowledge.

I understand that incorrect, misleading or incomplete information on this application may result in immediate termination of employment. I understand that this employment application and any other company documents are not contracts of employment and that any individual who is hired may voluntarily leave employment upon proper notice and may be terminated by the employer at any time and for any reason. I also understand that any oral or written statements to the contrary are expressly disavowed and should not be relied upon by any prospective or existing employee. I understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs before and during employment if allowed by law.

 Yes or No