Employment Application – Online

DATE OF APPLICATION

FIRST NAME

LAST NAME

MIDDLE NAME

DATE OF BIRTH

SOCIAL SECURITY NUMBER

Street

City

APT

STATE

ZIP

Home

ALT PHONE

NAME OF POSITION

EMAIL ADDRESS

FACEBOOK PAGE ADDRESS

EMPLOYMENT RECORD

IMPORTANT: LIST BELOW ALL PRESENT AND PAST EMPLOYMENT BEGINNING WITH MOST RECENT
MAY AN ENQUIRY BE MADE OF YOUR PRESENT EMPLOYER REGARDING YOUR CHARACTER, QUALIFICATIONS AND RECORD OF EMPLOYMENT? (A"NO" WILL NOT AFFECT YOUR CONSIDERATION FOR EMPLOYMENT.)

NoYes

1. DATES OF EMPLOYMENT (MONTH,YEAR)

FROM

TO

EXACT TITLE POSITION

OF EMPLOYEES YOU SUPERVISED

EMPLOYING FIRM

ADDRESS

CITY

STATE

ZIP

PHONE NO

AVERAGE FOR HOURS WEEK

SALARY OF EARNINGS

STARTING

PER

PRESENT

PER

REASON FOR WANTING TO LEAVE

DUTIES. RESPONSIBILITIES:

2. DATES OF EMPLOYMENT (MONTH,YEAR)

FROM

TO

EXACT TITLE POSITION

OF EMPLOYEES YOU SUPERVISED

EMPLOYING FIRM

ADDRESS

CITY

STATE

ZIP

PHONE NO

AVERAGE FOR HOURS WEEK

SALARY OF EARNINGS

STARTING

PER

PRESENT

PER

REASON FOR WANTING TO LEAVE

DUTIES. RESPONSIBILITIES:

A EDUCATION RECORD

HIGHEST GRADE COMPLETED

NAME OF HIGH SCHOOL:

HIGHEST GRADE COMPLETED

NAME OF HIGH SCHOOL:

GedDiploma

LOCATION:(CITY/STATE)

DATE COMPLETED

LIST ALL ADDITIONAL EXPERIENCE, TRAINING, EDUCATION, SKILLS OR QUALIFICATIONS RELATED TO THE POSITION FOR WHICH YOU ARE APPLYING. (EXAMPLES:" WORKING AS A CASHIER OR SELLING CARS")

ADDITIONAL EXPERIENCE, TRAINING, SKILLS, QUALIFICATIONS

LENGTH OF TIME TO BE CREATED (HRS,DAYS, MONTHS, YEARS)

1. COLLEGES/UNIVERSITY

NAME OF COLLEGES/UNIV

DATES ATTENDED FROM

DATES ATTENDED TO

CIRCLE ACADEMIC YRS. COMPLETED

DID YOU GRADUATE?
YesNo
TOTAL SEM HRS
TOTAL OTR HRS

A} DRIVER'S LICENSE INFORMATION

TYPE

STATE

NUMBER

YEAR OF RENEWAL

B} HAVE YOU EVER BEEN CONVICTED OF A FELONY?

YesNo

(A 'YES' ANSWER WILL NOT AUTOMATICALLY DISQUALIFY YOU FORM MOST JOBS)

CHARGE

DATE OF CONVICTION

STATE OF CONVICTION

C} REFERENCES

LIST THREE(3) PERSONS OTHER THAN RELATIVES WHO HAVE KNOWLEDGE OF YOUR CHARACTER OR ABILITY.

FULL NAME

MAILING ADDRESS(NO, STREET, CITY, ST, ZIP)

YRS. KNOWN

PHONE NO

NOTIFY IN CASE OF EMERGENCY

PRIMARY CONTACT:

NAME

RELATION

ADDRESS

CITY

STATE

ZIP

HOME PHONE

WORK PHONE

SECONDARY CONTACT:

NAME

RELATION

ADDRESS

CITY

STATE

ZIP

HOME PHONE

WORK PHONE

VERY IMPORTANT NOTICE

I HEREBY GIVE PERMISSION TO THE YUM YUM'S GOURMET POPCORN CO. OR IT'S DULY AUTHORIZED REPRESENTATIVE TO CONTACT ANY PERSONS OR COMPANIES NAMED IN THIS STATEMENT OTHER THAN MY PRESENT EMPLOYER AND VERIFY ANY AND ALL EDUCATIONAL, HISTORY THAT I HAVE GIVEN ON THIS STATEMENT.

I HEREBY AUTHORIZE MY FORMER EMPLOYERS TO FURNISH THEIR RECORDS OF MY SERVICE, MY REASONS FOR LEAVING THEIR COMPANY TOGETHER WITH ALL INFORMATION THEY MAY HAVE CONCERNING ME. I ALSO RELEASE ANY INDIVIDUAL PARTNERSHIP OR CORPORATION WHICH FORMERLY EMPLOYED ME, IT'S OFFICERS, AGENTS AND EMPLOYEES FROM ANY LIABILITY AND ANY DAMAGE THAT MAY OCCUR FOR ISSUING SUCH INFORMATION.

I DO HERE BY AFFIRM THAT I HAVE ANSWERED ALL QUESTIONS AND NOT OMITTED ANY INFORMATION TO THE BEST OF MY ABILITY AND BELIEF. I UNDERSTAND THAT IF ANY OF THE STATEMENTS MADE BY ME ON THIS STATEMENT ARE FALSE OR IF A CHECK WITH MY FORMER EMPLOYER REVEALS THAT I WOULD MAKE AN UNSATISFACTORY EMPLOYEE I MAY BE SUBJECTED TO IMMEDIATE DISQUALIFICATION OR TERMINATION.

I DO HEREBY AFFIRM THAT IN ACCORDANCE WITH FEDERAL LAW. I WILL PROVIDE PROOF OF IDENTITY AND EMPLOYMENT ELIGIBILITY IF I AM HIRED. I ALSO WILL BE WILLING TO TAKE A DRUG OR ALCOHOL TEST IF ASKED BEFORE I'M HIRED AND OR DURING MY EMPLOYMENT AT ANY TIME.