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2 IN 1 QUICKCHECK APPLICATION

Date of Application:
Position(s) applied for:
Name:
Address:
Phone Number:
Mobile/Beeper/Other Phone:
-
E-mail:

If you are under 18, and it is required, can you furnish a work permit? 

*
If NO, please explain:

Have you ever been employed here before? If yes, give dates and positions: 

*
If yes, give dates and positions:

Are you legally eligible for employment in this country? 

*
Date available for work:
What is your desired salary range?
Type of Employment Desired: *

Are you able to meet the attendance requirements of the positions? 

*

Have you ever pled "guilty" or "No contest" to, or been convicted of a crime? 

*
If yes, please provide date(s) and details:

Answering "yes" to these questions does not constitute an automatic bar to employment.
Factors such as date of the offense, seriousness and nature of the violation,
rehabilitation and position applied for will be take into account. 

Driver's license number if driving is an essential job function:
State issued:

EMPLOYMENT HISTORY:

Please provide the following information of your past four (4) employers, assignments or volunteer activities, starting with the most recent. 

From
To
Employer:
Employer Phone:
-
Address:
Starting Job Title/Final Job Title:
Immediate Supervisor and Title:
Summarize the nature of work performed and job responsibilities:

May we contact for reference? 

Reason for Leaving:
Hourly Rate/Salary: Start:
Hourly Rate/Salary: Final:
From *
To
Employer: *
Employer Phone:
-
Address:
Starting Job Title/Final Job Title:
Immediate Supervisor and Title:
Summarize the nature of work performed and job responsibilities:

May we contact for reference? 

Reason for Leaving:
Hourly Rate/Salary: Start:
Hourly Rate/Salary: Final:
From:
To
Employer:
Employer Phone:
-
Address:
Starting Job Title/Final Job Title:
Immediate Supervisor and Title:
Summarize the nature of work performed and job responsibilities:

May we contact for reference? 

Reason for Leaving:
Hourly Rate/Salary: Start:
Hourly Rate/Salary: Final:

Including explanation of gaps in employment, exclude comments that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve, National Guard or any other similarly protected status. 

SKILLS AND QUALIFICATIONS

Summarize any training, skills, licenses and/or certificates tat may qualify you as being able to perform job-related functions in the position for which you are applying.

Explain here:

EDUCATIONAL BACKGROUND: (If job related)

NAME AND LOCATION

HIGH SCHOOL
NUMBER OF YEARS COMPLETED

DID YOU GRADUATE? 

COURSE OF STUDY

NAME AND LOCATION

COLLEGE
NUMBER OF YEARS COMPLETED

DID YOU GRADUATE? 

MAJOR
DEGREE:
COURSE OF STUDY

REFERENCE

Name:
Number:
NUMBER OF YEARS KNOWN:

REFERENCE

Name:(1)
Number:(1)
NUMBER OF YEARS KNOWN:(1)

REFERENCE

Name:(2)
Number:(2)

WRITING SKILLS

In the space provided, please write why you feel you would be an asset to this company and what job-related characteristics you possess that differentiate you from other applicants. Please include at least four to five sentences. *