Bizee Mart

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Employment Application

Programs, services, and employment are equally available to everyone. Please inform the Human Resources Date of Review (Month/Day/Year) Department if you require reasonable accommodation for the application or interview.

Applicant Data

APPLICANT DATA:

Position Applied for:

Applied for which store location:

Full Name

Address

Phone No.

Mobile / Pager / Other

Date Available to Start:

Social Security:

Salary Requirement:

If you are under 18 and we require a work permit, can you furnish one?

Yes

If No, Plese Explain :

Have you ever worked for this company?

Yes

If yes, When? :

Are You a citizen of the United States?

Yes

If not, are you Legally allowed to work in the United States?

Yes

Type of Employment desired:

Full-Time

Part-Time

Temporary

Seasonal

Have you ever pleaded "guilty," "no Contest," or been convicted of crime?

Yes

If yes, give dates and details :

Answering "yes" to these questions does not constitute an automatic rejection for emloyment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Driver's license number if applicable to position:

SUMMARIZE YOUR SPECIAL SKILLS OR QUALIFICATIONS:

PREVIOUS EMPLOYMENT (begin with most recent position):

Dates of Employment

From :

To :

Position(s) Held:

Firm :

Address:

Phone :

Supervisor :

Title:

Responsibilities:

Starting Salary and Title :

Ending Salary and Title:

Reason for Leaving:

May we contact this employer for a reference?

Yes

I certify that my answers are true and complete to the best of my know ledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or ind ividuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

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