Please print application and drop it at any of our locations.

Tala’s DistantTreasures

EMPLOYMENT APPLICATION FORM

Applicant Information

Applicant Name :_____________________
Home Phone :_______________________
Cell :____________________________
Email Address :_____________________

Current Address:_______________________
Number and street :____________________
City :________________________________
State & Zip :____________________________

Date of Birth: ________________________

Social Security number:  ______________________

Employment Positions

Are you applying for:

• Temporary work – such as summer or holiday work? [ ] Y or [ ] N
• Regular part-time work? [ ] Y or [ ] N
• Regular full-time work? [ ] Y or [ ] N
• Are you applying for  Crestview [ ]   Newport [ ]   Kenwood  [ ]  Florence  [ ] 

 
What days and hours are you available for work?___________________________________________
If applying for temporary work, when will you be available? ___________________________________________

If hired, on what date can you start working? ___ / ___ / ___

Can you work on the weekends? [ ] Y or [ ] N

Can you work evenings? [ ] Y or [ ] N

Are you available to work overtime? [ ] Y or [ ] N

Salary desired: $________________________________

Personal Information:

Have you ever applied to / worked for Company before? [ ] Y or [ ] N
If yes, please explain (include date): ________________________

Do you have any friends, relatives, or acquaintances working for Company? [ ] Y or [ ] N
If yes, state name & relationship: ________________________________

If hired, would you have transportation to/from work? [ ] Y or [ ] N

Are you over the age of 18? [ ] Y or [ ] N

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? [ ] Y or [ ] N 

Have you ever been convicted of a criminal offense (felony or misdemeanor)? [ ] Y or [ ] N  

Education, Training and Experience

High School:
School name: ________________________
School address:________________________
School city, state, zip:________________________________

Number of years completed: _______________
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: _______________

College / University:
School name: __________________________
School city, state, zip:________________________________

Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: __________________

Additional Information

Do you speak, write or understand any foreign languages? [ ] Y or [ ] N

If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be. ____________________

Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us?
[ ] Y or [ ] N

If yes, please explain:

Employment History:

Present Or Last Position:

Employer: _____________________________________________________

Address:______________________________________________________

Supervisor: ____________________________________________________

Phone: _______________________________

Email: ________________________________

Position Title: _________________________

From: ______________ To: ______________

Responsibilities: ____________________________________________________

__________________________________________________________

Salary: _______________

Reason for Leaving: ____________________________________________

===========

Previous Position:

Employer: _____________________________________________________

Address:______________________________________________________

Supervisor: ____________________________________________________

Phone: _______________________________

Email: ________________________________

Position Title: _________________________

From: ______________ To: ______________

Responsibilities: ___________________________________________________

__________________________________________________________

Salary: _______________

Reason for Leaving: ____________________________________________

May We Contact Your Present Employer?

Yes _____ No _____

References:

Name/Title Address Phone

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

I certify that information contained in this application is true and complete.

I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Signature______________________________

Date__________________________________