Employment Application – Schmidts Wholesale

APPLICATION PERSONAL INFORMATION

Date

Location*

Monticello
Florida

Name*

First Middle Last

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

1. Are you 18 years of age or older?*

If not, state your age:*

If hired and you’re under 18 years of age, can you furnish a work permit

2. Have you filed an application here before?

Yes
No

If yes, when?:

3. Have you ever been employed here before?

Yes
No

If Yes, please give dates:

4. Please list the name any relatives you have who are already employed by the Company:

5. What date will you be available for work?

6. Are you available to work:

Full-Time
Part Time
Temporary

7. Are you legally eligible to work in the United States?

Yes
No

8. Have you ever been convicted of a crime?

Yes
No

If yes, please explain:

A qualified applicant will not be denied employment because of a conviction record, unless there is a direct relationship between the offense convicted for and the position for which he or she is applying or unless hiring would be an unreasonable risk

9. Are you a veteran of the United States Armed Forces or a state militia?

Yes
No

Did you receive a dishonorable discharge?

Yes
No

10. Do you possess a valid New York State Driver’s license?

Yes
No

SPECIAL SKILLS AND QUALIFICATIONS

Summarize any special skills and/or qualifications, which you have acquired from prior employment or other experiences, which you consider relevant to your ability to perform the position(s) for which you are applying.

Education

Elementary

School Name & Address of School, and course of study.

Level completed

Click the last year completed.

5
6
7
8

Did you graduate?

Yes
No

High School

School Name & Address of School, and course of study.

Level completed

Click the last year completed.

9
10
11
12

Did you graduate?

Yes
No

List Degree / Diploma Received

College / University

School Name & Address of School, and course of study.

Level completed

Click the last year completed.

1
2
3
4

Did you graduate?

Yes
No

List Degree / Diploma Received

Other

School Name & Address of School, and course of study.

Level completed

Click the last year completed.

1
2
3
4

Did you graduate?

Yes
No

List Degree / Diploma Received

Additional Memberships

11. List your memberships, if any and offices held, professional, trade, business, Civic or other organizations, which you consider relevant to your ability to perform the position(s) for which you are applying. You may exclude those Memberships or offices held in organizations, which indicate race, color, Creed, religion, sex, national origin, ancestry, age, handicap or disability, or marital or veteran status.

EMPLOYMENT EXPERIENCE

Beginning with your most recent employment, provide the information. You may include any military service or volunteer experiences, which you consider relevant to your ability to perform the position(s) for which you are applying. You may exclude any experience, which indicate race, color, Creed, religion, sex, national origin, ancestry, age, handicap or disability or marital status.

Company Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Dates of Service

Reason For Leaving

Supervisor

Rate of Pay (hourly or salaried)

Starting Pay and Ending Pay

Work Performed / Responsibilities

Company Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Dates of Service

Reason For Leaving

Supervisor

Rate of Pay (hourly or salaried)

Starting Pay and Ending Pay

Work Performed / Responsibilities

Company Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Dates of Service

Reason For Leaving

Supervisor

Rate of Pay (hourly or salaried)

Starting Pay and Ending Pay

Work Performed / Responsibilities

REFERENCES

Give the name, address, telephone number, dates and number of years acquainted of these references who are not related to you and who are not previous employers.

Reference #1

Name, Address, Telephone number, Relationship

Reference #2

Name, Address, Telephone number, Relationship

Reference #3

Name, Address, Telephone number, Relationship

APPLICANT STATEMENT

I hereby certify that the information given in this Application for Employment will be given by me, and that each entry made by me will be true to the best of my knowledge and understanding. I understand that the making of false, misleading or incorrect statements will be sufficient cause for immediate termination upon discovery thereof regardless as to consideration for employment will be given to me, if an applicant or if seeking rehire or reinstatement. I authorize the company to make inquiry of any of my former employers, or references, as to my employment, compensation, experience, job suitability, education, or reasons for leaving; and any inquiry to any other agency, institution or person about any information provided by me in this, my Application for Employment. Such inquiries may include my driving record. I understand that an investigation may be made whereby information is obtained through personal interviews with people who know me and that this inquiry includes information as to my character, general reputation, personal characteristics, or mode of living, whichever may be applicable and I authorize the Company to make such inquiry. Information in violation of state or federal fair employment practice laws will not be sought or used by the Company. In consideration of my employment, should I be employed by Schmidt’s Wholesale Inc., I agree to conform to the rules and regulations of my Employer as they exist or as they may be changed from time to time, at the option of either the Employer of myself. I understand that no other than the President or an officer of the Company by which I am employed has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement concerning benefits or conditions, or to make any expressed or implied commitment concerning benefits or conditions that are at variance with published Company policies, or to make any Agreement, contrary to the foregoing.

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