Employment Application

PERSONAL INFORMATION
Name (Last Name First) PRESENT ADDRESS PERMANENT ADDRESS PHONE NUMBER CITY CITY

Pre-Employment Questionnaire

Equal Opportunity Employer

SOCIAL SECURITY NUMBER STATE STATE REFERRED BY ZIP CODE ZIP CODE

DATE OF APPLICATION

EMPLOYMENT DESIRED
POSITION ARE YOU CURRENTLY EMPLOYED? CIRCLE ONE: HAVE YOU EVER WORKED FOR THIS COMPANY? DATE AVAILABLE TO START IF SO, MAY WE CONTACT YOUR EMPLOYER? IF SO, WHERE? HOURLY RATE DESIRED

YES YES

NO NO

YES WHEN?

NO

NAME AND LOCATION OF SCHOOL

HIGH SCHOOL

YEARS ATTENDED/GRADUATE?
_______ Yrs. / YES YES YES NO NO NO

SUBJECTS STUDIED

COLLEGE
_______ Yrs. /

TRADE, BUSINESS, OR OTHER

_______ Yrs. /

GENERAL
SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL TRAINING/SKILLS DAYS AND TIMES AVAILABLE TO WORK (ex. "all day", "no", "3-9", "mornings", etc.) TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY YES NO EXPLAIN: RANK

MONDAY

HAVE YOU EVER BEEN CONVICTED OF A CRIME? MILITARY SERVICE? YES NO WHICH BRANCH?

FORMER EMPLOYERS (List below your last four employers, starting with the last one first)
FROM: FROM: FROM: FROM: TO: TO: TO: TO: NAME AND ADDRESS NAME AND ADDRESS NAME AND ADDRESS NAME AND ADDRESS SALARY: SALARY: SALARY: SALARY: POSITION: POSITION: POSITION: POSITION: REASON FOR LEAVING REASON FOR LEAVING REASON FOR LEAVING REASON FOR LEAVING

REFERENCES (Give the names of three persons not related to you, whom you have known at least one year)
NAME ADDRESS PHONE YEARS KNOWN

NAME

ADDRESS

PHONE

YEARS KNOWN

NAME

ADDRESS

PHONE

YEARS KNOWN

Employment Application
1.

Pre-Employment Questionnaire

Equal Opportunity Employer

Please complete the following additional Smoothie King application questions:

Why would you want to work at SMOOTHIE KING?

2.

What are your hobbies and interests?

3.

Please list your extra-curricular activities, either school or non-school related.

AUTHORIZATION "I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY HAVE, PERSONAL OR OTHERWISE, AND RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION. I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR MAKE ANY AGREEMENT CONTRARY TO THE AGREEMENT FORGOING, UNLESS IT IS IN WRITING SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE."

DATE: __________________

SIGNATURE: __________________________________________________________________ DATE: ____________________

INTERVIEWED BY: _____________________________________________________________

______________________________________DO NOT WRITE BELOW THIS LINE_____________________________________ REMARKS

HIRE DATE

START DATE

POSITION

WAGE