We are an equal opportunity
employer. All applicants will be considered without
regard to age, color, national origin, religion, disability,
sex, or other protected status in accordance with applicable
federal and state equal employment opportunity laws.
First Name:
Last Name:
Address:
City:
State:
Zip:
 Phone:
Email:
Social Security Number:
Date Available for Employment:
If employed and under 18, can you furnish
a work permit?
Yes
No
Have you ever been employed by this
company?
Yes
No
If yes please give date (s):
to
Are you employed now?
Yes
No
If yes how much notice will your present
employer require:
May we contact your present employer?
Yes
No
If yes, give name:
Phone number
Type of work desired or position applying
for:
If applying for a position where
driving is required:
Do you have a valid drivers license
in the State of Tennessee?
Yes
No
Drive’s license number:
Can you perform the essential functions
of the job(s) for which you are applying?
Yes
No
Are you available to work:
FULL-TIME
PART-TIME
OVER-TIME
Have you been convicted of a felony?
Yes
No
(Please note that a “YES” answer will
not bar you from consideration for employment)
If YES, please explain including state
in which convicted:
This company is an equal opportunity
employer. All applicants will be considered without
regard to age, color, national origin, religion, disability,
sex, or other protected status in accordance with
applicable federal and state equal employment opportunity
laws. This company will strive to accommodate any
physical or mental limitations of employees or applicants
in order to accomplish the essential functions of
a job.
EDUCATION:
ELEMENTARY
High School
COLLEGE GRADUATE
Last School Attended
NAME
YEARS
Grades Completed
4
5
6
7
8
9
10
11
12
College:
Course of Study:
Additional schooling / certifications:
List three (3) non-relatives who are
familiar with your qualifications and actual work
history and ability.
1. Name:
Occupation:
Relationship:
Years Known:
Phone:
2. Name:
Occupation:
Relationship:
Years Known:
Phone:
3. Name:
Occupation:
Relationship:
Years Known:
Phone:
Start with your present job
or last job. List your last four (4) jobs in order.
Do not omit any job.
Employed from
to:
Employer
Supervisor:
Address:
Phone:
Position held:
Salary: Starting:
Ending:
Duties:
What did you like most about your job
or least about your job:
Reason for leaving:
Employed from
to:
Employer
Supervisor:
Address:
Phone:
Position held:
Salary: Starting:
Ending:
Duties:
What did you like most about your job
or least about your job:
Reason for leaving:
Employed from
to:
Employer
Supervisor:
Address:
Phone:
Position held:
Salary: Starting:
Ending:
Duties:
What did you like most about your job
or least about your job:
Reason for leaving:
Employed from
to:
Employer
Supervisor:
Address:
Phone:
Position held:
Salary: Starting:
Ending:
Duties:
What did you like most about your job
or least about your job:
Reason for leaving:
COMPUTER EXPERIENCE / KNOWLEDGE:
I FEEL MY STRENGTH LIES IN MY ABILITY
TO:
I FEEL MY CO-WORKERS WOULD DESCRIBE
ME AS:
I FEEL MY WORK RELATED WEAKNESSES ARE:
1. Recall an incident where you made a major mistake.
What did you do after the mistake was made? What did
you learn from this mistake?
2. Tell us about a pressure situation
you were in that would demonstrate your ability to
work under pressure.
3. You are buying a bike for you son
at Wal-Mart and it is priced at $99.00. When you go
to check out, it rings up for $79.00. What would you
do?
4. What can you add to what we have
already asked you that should make us want to hire
you?
I certify that all answers and
statements I have made on this application (and resume
or other supplementary materials) are true and complete
without omissions. I understand that any false information
will result in refusal to hire or immediate discharge
if I am employed. I authorize any of the persons or
organizations named in this application to give you
complete information and records regarding my employment,
education, character, and qualifications.
Signature:
Date:
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