Big Sandy Superstore: Employment Application

Employment Application

Note on Previous Employers:

Begin with your present or last work experience.
Include volunteer work experiences.
Leave the Armed Forces section blank if you have no Armed Forces experience.

Note: Required fields are marked with an asterisk (*)

Application Information

Location you're applying to *

* Position you're applying for

Contact Information

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone Number *

Example: 7405551234

Questionnaire

Are you 18 years old or older? *
If no, can you provide a work permit, if necessary? *
Did you complete high school? *
Did you complete college? *
If yes, what field?
Do you have special licensing or certification? *
If yes, what field?
Can you provide proof of legal right to work in this country? *
Do you speak English? *
Do you speak other languages? *
If yes, which ones? (Hold down the [Ctrl] key to select more than one)
Can you work in a non-smoking environment? *
Can you work weekends, evenings, shifts? *
Are you willing to undergo a drug screen? *
Have you ever been disciplined or fired from a job? *
If yes, please explain
Can you travel, if required? *
Have you been convicted of a felony within the last 7 years? (A yes or no answer to this question does not necessarily disqualify applicant from employment.) *
Have you worked at this company before? *
Have you applied to this company before? *
Are you related to an employee of this company? *

Previous Employer 1

Company Name *

Start Date * use (MMDDYYYY)

End Date * use (MMDDYYYY)

Address *

City *

State *

Zip Code *

Last Position Title *

Starting Salary *

Ending Salary *

Hours worked per week *

Immediate Supervisor *

Phone Number * (Ex: 7405551234)

Duties, responsibilities, and number supervised *

Reason for leaving *

I indicate my willingness for you to talk with this previous employer: *

YES NO

Previous Employer 2

Company Name *

Start Date * use (MMDDYYYY)

End Date * use (MMDDYYYY)

Address *

City *

State *

Zip Code *

Last Position Title *

Starting Salary *

Ending Salary *

Hours worked per week *

Immediate Supervisor *

Phone Number * (Ex: 7405551234)

Duties, responsibilities, and number supervised *

Reason for leaving *

I indicate my willingness for you to talk with this previous employer: *

YES NO

Previous Employer 3

Company Name *

Start Date * use (MMDDYYYY)

End Date * use (MMDDYYYY)

Address *

City *

State *

Zip Code *

Last Position Title *

Starting Salary *

Ending Salary *

Hours worked per week *

Immediate Supervisor *

Phone Number * (Ex: 7405551234)

Duties, responsibilities, and number supervised *

Reason for leaving *

I indicate my willingness for you to talk with this previous employer: *

YES NO

Armed Forces Work Experience

Start Date use (MMDDYYYY)

End Date use (MMDDYYYY)

Immediate Supervisor

Means of Contacting Supervisor

Duties, responsibilites, and number supervised

I indicate my willingness for you to talk with this previous employer:

YES NO

Additional Skills

DO YOU HAVE EXPERIENCE IN THE FOLLOWING (CHECK ALL THAT APPLY)

Record Keeping	General Ledger	Dictaphone	Internet Use	Bank Reconciliation
Trial Balance	10 Key	Computer Software	Accounts Receivable	Financial Statements
Calculator	Cash Register	Accounts Payable	Full Charge Bookkeeper	Statistical Typing
Lotto Machine	Payroll	PBX Switchboard

Typing Speed WPM (Words per Minute)

List of Other Related Skills

Driving Experience and Qualifications

Current License State

License Type

Expiration Date use (MMDDYYYY)

Have you ever been denied a license permit, or privilege to operate a motor vehicle?

YES NO

Has any license, permit, or privilege ever been suspended or revoked?

YES NO

I request and authorize disclosure of my driving record from the Department of Motor Vehicles to the employer who is considering me for employment

YES NO

Applicant's Agreement

If I misrepresent or deliberately leave out a fact in my application, I may be refused employment or, if employed, I may be terminated.
If employed, I may terminate my employment at any time without notice or cause, and the Company may terminate or modify the relationship at any time without notice or cause. I agree to conform to the rules and regulations of the Company and I understand that no department head or representative of the Company, other that the president or designated officer of the Company, has the authority to enter into any agreement for employment for any specified period of time or make any agreement contrary to the Agreement.
As a condition of employment or my continued employment, I may be requested by the Company to submit to a urinalysis, drug screen, and/or other tests and that my failure to take such test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am then employed, may result in immediate termination.
Although management attempts to accommodate individual circumstances, including religious observance requirements, business needs may at times make the following conditions required: overtime, rotating work schedule, or work schedule that includes Saturday and Sunday.
If employed, my employment is for no definite period of time, and if terminated, the Company is liable only for wages or salary earned as of the date of termination.
I authorize the Company to verify all information provided by me and to contact any organization or individual that I have listed on my employment application or resume mentioned in job interviews and obtain from them any relevant information about my job qualifications, including my experience, skills, and abilities. I understand that I am consenting to the release of my reference-related information about me held or known by my former employers, supervisors, and co-workers. In addition, I consent to the release of any information about my education, experience, abilities, performance, attendance, conduct, or other work-related characteristics or issues held or known by other organizations or individuals, including schools and educational institutions, professional or business associates, and friends and acquaintances that the Company might contact in the course of conducting a reference check or background investigation of my suitability for employment or procuring or having a police report prepared for this purpose.

I understand and acknowledge that this release of information can involve my qualifications, performance, credentials, or other characteristics of factors affecting my suitability for employment with the Company.

In exchange for the Company's consideration of my employment application, I release the Company and any organization or individual it may contact pursuant to paragraph six from any and all damages, liabilities, or claims that may exist or arise relating in any way to the release or receipt of information as provided herein. I further agree not to file or pursue any complaint claims or legal actions of any kind against any organization or individual that provides work-related information about me to the Company or it agents in accordance with the terms and intent of this release. I also agree not to file or pursue any complaints, claims, or legal actions against the Company or any of its employees, representatives, or agents arising out of their efforts to obtain work-related information about me.
I have read and agree to the above. I hereby certify that the facts I have provided in this employment application are true and complete.

By checking "YES" I submit this application as if signed. *

YES NO

This application for employment is produced for general use throughout the United States/Canada. U.S. Personnel, Inc. assumes no responsibility for the said form or any questions which, when asked by the employer of the job applicant, may violate State/Province and/or Federal Law.

Master Bedroom Youth Bedroom Comforter Sets

Casual Dining Master Dining

Accessories Desks

Entertainment Centers Ready To Assemble

Leather Motion Sofas Occasional Tables Recliners Sectionals Sleepers Sofas

Air Conditioners Dishwashers Dryers Freezers Microwaves Ranges Refrigerators Washers

Flat Panels Home Theater Rear Projection Closeouts

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