Last Name *

First Name *

Middle Name

Street Address *

City *

State *

ZIP *

Phone Number *

Email *

Have you ever been employed by this company?

Yes No

If yes, when?

Willing to work:

Full Time Part Time Weekends Overtime

Date you can start work *

Are you currently employed?

Yes No

Do you have a High School Diploma or GED? *

Yes No

Are you authorized to work in the U.S. on an unrestricted basis? *

Yes No

Have you ever been convicted of a felony? *

Yes No

If yes, please explain

Reference #1 - Full Name *

Reference #1 - Address

Reference #1 - Phone *

Reference #1 - Relationship *

Reference #2 - Full Name *

Reference #2 - Address

Reference #2 - Phone *

Reference #2 - Relationship *

Reference #3 - Full Name *

Reference #3 - Address

Reference #3 - Phone

Reference #3 - Relationship

Job #1 - Title *

Job #1 - Company *

Job #1 - Start Date *

Job #1 - End Date

Job #1 - Supervisor

Job #1 - Phone

Job #1 - Duties *

Job #2 - Title

Job #2 - Company

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application. I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

I have read and agree to the above statement

Date *

Full Name (Signature) *

PAYLESS THRIFT MISC. SORTER

Employment Application

personal

position

references

work history

acknowledgment