Application for Employment

Personal Information

Last Name

First Name

Present Address

Home Phone No.

Cell Phone No.

Email

Age

Do you have a Social Security number?

Yes
No

Employment Desired

Position

Date you can start

Salary Desired

Are you employed?

Yes
No

If so, may we inquire of your present employer?

Yes
No

Are you looking for:

Part time
Full time
Any of them

Could you work from 8:00 am to 5:00 pm?

Yes
No

Are you able to work weekends?

Yes
No

Education History

Education Level

Name of Institution

Location of Institution

Years attended

Did you graduate?

Yes
No

Subjects studied

Do you speak any other language?

Yes
No

If yes, please select

Spanish
French
Portuguese
Creole
Other

Former employers

Employer 1

Name of employer

Date from - to

Telephone

Address

Position

Salary

Reason for leaving

Employer 2

Name of employer

Date from - to

Telephone

Address

Position

Salary

Reason for leaving

References

Give below the names of three persons not related to you, whom you have known at least one year.

Reference 1

Full Name

Telephone

Address

Years to know

Reference 2

Full Name

Telephone

Address

Years to know

Reference 3

Full Name

Telephone

Address

Years to know

Character

Do you mind working with animals?

Yes
No

Are you afraid of dogs?

Yes
No

Between 1 to 10 how detail oriented are you?

Have you ever been convicted of a felony?

Yes
No

What do you think you will enjoy the must about working here?

What motivates you to do a job well done?

How long do you see yourself working at crazy tails grooming salon?

1 month
3 months
6 months
1 year or more

Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained here in and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

Signature

Date

Application for Employment

Personal Information

Employment Desired

Education History

Former employers

Employer 1

Employer 2

References

Reference 1

Reference 2

Reference 3

Character

Authorization

Credentials

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