Application for Employment

Personal Information

First Name: Last Name Middle Name:
Any other name used in previous employment (I.E. maiden, nickname):
Address: City: State: Zip: How Long?
Previous Address: City: State: Zip: How Long?
Telephone Number.: Email Address:

Education

High School Name & Address: No. Years: Year Left: Graduate: Degree: Course - Spec.
College Name & Address: No. Years: Year Left: Graduate: Degree: Course - Spec.
Technical or Commercial Name & Address: No. Years: Year Left: Graduate: Degree: Course - Spec.
Other Name & Address: No. Years: Year Left: Graduate: Degree: Course - Spec.

Other Information

Type of Work Applied for: Date Available to Start Work: Location Applied for: *required
About what salary would seem reasonably satisfactory to you to start: Per Week: After 1 year:
Special Training or other Qualifications which fit you for this type of work:
Hobbies, Sports:
Have you or any relative ever been employed by Treasure Hunt and Dirt Cheap?  
If YES, give name of person employed, store location and the date of employment:
Total Length of Military Service: Type of Discharge: Date: Rank: Branch:
Have you ever been convicted of a crime? *required  
If YES, when, where and disposition of offense:

Criminal history will considered, but might not be deemed disqualifying. Concealment or misrepresentation of criminal history will be deemed disqualifying.
To be filled out by clerical applicants only: Typing: WPM: Shorthand: WPM:
List any other machines you operate:

a. Employment History

Job Title: Employer:
Street Address:
City: State:
Zip: Type of Business:
Immediate Supervisor:
Salary (start): Salary (finish):
Dates (mon/yr): To (mon/yr):
Status: Hours/week:
Duties:
Number and titles of employees you supervised:
Equipment used:
Reason for leaving:
Your name if different from present:

b. Employment History

Job Title: Employer:
Street Address:
City: State:
Zip: Type of Business:
Immediate Supervisor:
Salary (start): Salary (finish):
Dates (mon/yr): To (mon/yr):
Status: Hours/week:
Duties:
Number and titles of employees you supervised:
Equipment used:
Reason for leaving:
Your name if different from present:

c. Employment History

Job Title: Employer:
Street Address:
City: State:
Zip: Type of Business:
Immediate Supervisor:
Salary (start): Salary (finish):
Dates (mon/yr): To (mon/yr):
Status: Hours/week:
Duties:
Number and titles of employees you supervised:
Equipment used:
Reason for leaving:
Your name if different from present:

d. Employment History

Job Title: Employer:
Street Address:
City: State:
Zip: Type of Business:
Immediate Supervisor:
Salary (start): Salary (finish):
Dates (mon/yr): To (mon/yr):
Status: Hours/week:
Duties:
Number and titles of employees you supervised:
Equipment used:
Reason for leaving:
Your name if different from present:
I have answered all of the questions on this application correctly and honestly. I allow you to investigate my statements. I consent that discovery of any falsification, or concealment of material information, shall end my consideration of my application, or result in my dismissal, if employed. I understand that you will assume, after the passage of thirty days, that I have found other work, or am no longer interested, unless I contact you and renew my application in writing.