Employment - Career Opportunities

Customer Service
Online Application

Personal

How did you hear about the position?
Last Name
First Name	Middle Initial
Street Address
City		State	Zip Code
Home Phone #	Business # Cell #
Social Security #	Example: 012-61-3251
Email Address
If you are under 18 years of age, can you provide required proof of your eligibility to work?				Yes No
Have you ever filed an application with us before?				Yes No
Have you ever been employed with us before?				Yes No
Are you currently employed?				Yes No
Are you legally eligible for employment in the United States? (Proof of of identity and eligibility will be required upon employment)				Yes No
Are you currently on "lay-off" or "stand-by" status and subject to employment recall?				Yes No
on what date would you be available to work? One week Two weeks Immediately >h k Other
Are you able to perform the duties of the position for which you are applying with or without a reasonable accommodation?				Yes No

Education & Training

High School City Graduated Yes No >>Diploma
College	Major	Years Attended	Credits Completed	Degree



List any other education, training, special skills or certificates/licenses that you possess related to this job.

Employment Experience

Name of current or last employer

Employer Name Phone#

Employer Address Type of Business

Date Employed: from t o Reason for leaving

Supervisor Name May we contact: Yes No

Describe job Full Time Part Time

Name of current or last employer

Employer Name Phone#

Employer Address Type of Business

Date Employed: from t o Reason for leaving

Supervisor Name May we contact: Yes No

Describe job Full Time Part Time

Name of current or last employer

Employer Name Phone#

Employer Address Type of Business

Date Employed: from t o Reason for leaving

Supervisor Name May we contact: Yes No

Describe job Full Time Part Time

References List business persons known for at least three years who are not related to you!

Name	Title	Business	Phone	Years Known

General Information

Do you have a valid driver's license? Yes No ...... Do You have dependable transportation? Yes No

Hobbies & Interests
Music
Sports
Other

Comments

List any comments or qualifying statements you care to make in reference to this position.

Occupational Skills

Do you own a personal computer? Yes No ............ Type
How would you rate your keyboard typing ability ?........... Poor Average Advanced
Rate your knowledge of the following applications
Internet:	No Knowledge......... Some Knowledge......... Proficient.......... Master
Windows:	No Knowledge......... Some Knowledge......... Proficient.......... Master
MS Word:	No Knowledge......... Some Knowledge......... Proficient.......... Master
MS Excel:	No Knowledge......... Some Knowledge......... Proficient.......... Master
MS Powerpoint:	No Knowledge......... Some Knowledge......... Proficient.......... Master
MS Outlook:	No Knowledge......... Some Knowledge......... Proficient.......... Master
MS Publisher:	No Knowledge......... Some Knowledge......... Proficient.......... Master
Adobe Acrobat :	No Knowledge......... Some Knowledge......... Proficient.......... Master
20-20 Design :	No Knowledge......... Some Knowledge......... Proficient.......... Master
Other

Availability

The position for which you are applying requires that you work the schedule detailed below.
Full Time	Closed Holidays	Working Holidays
Monday - 8:30am to 5:00pm	Easter	Labor Day
Tuesday - 8:30am to 5:00pm	Thanksgiving	Independance Day
Wednesday - 8:30am to 5:00pm	Christmas	Memorial Day
Thursday - 8:30am to 5:00pm	New years day
Friday - 8:30am to 5:00pm
Saturday - 8:30am to 5:00pm (alternating)
Sunday -Off
Do you have any present commitments that would prevent you from working this schedule?		Yes No
Some office positions may require working mandatory overtime. Is there any reason why you would not be able to fulfill this commitment?		Yes No
If so, explain

Consumers Education

If hired, would you be willing to complete required after-hour training courses? ..................... Yes No

If hired, would you be willing to complete required after-hour training seminars? ..................... Yes No

Salary
I understand the position I am applying for offers a starting salary of $13.50 per hour for the first 40 hours worked per week and $20.25 per hour for any hours worked in excess of 40 hours in a week.	Yes No
......................... ...

Applicant's Certification Please read before accepting!

I certify that, to the best of my knowledge and belief, the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete. I understand that any false information contained in this application may result in my discharge. I authorize you to communicate with all my former employees, school officials and persons named as references. I hereby release all employers, schools and individuals for any liability for any damage whatsoever resulting from giving such information. I understand that as this organization deems necessary, I may be required to work overtime hours or hours outside a normally defined workday or work week. If employed, I understand and agree that such employment may be terminated at any time and without any liability to me for any continuation of salary, wages or employment related benefits. I acknowledge the above certification by checking the accept box and pressing the submit form button.

I accept the Applicant's Certification.