Application for
Employment
Please Complete all Information Requested
General Information
Last Name:
First Name:
Middle Initial:
Present
Address ( street, city, state, zip )
Former
Address if at present address less than two (2) years (street, city,
state, zip):
Home
Phone: Work
Phone: Social Security #:
Are
you legally authorized to work in the United States? Yes
No
Are
you 18 years of age or older?
Yes No
What
position are you applying for? Receptionist
Florist
Other
Referral
Information
How
were you referred to DiBarry's Flower Shoppe? Newspaper
Website Walk-in
Referral Other
Work
Information
What
type of employment are you seeking?
Full Time Part
time Temporary
Seasonal
What
is the minimum number of hours you are available?
What
is the maximum number of hours you are available?
When
are you available to being employment?
Can
you work a flexible schedule (Different days and number of hours each
week)? Yes No
Are
you available to work: On
Call (short notice) Extended
Hours New Years Day Day
before Christmas Day
After Christmas
Work
History
Dates:
From
To
Month
Year
Month
Year
Name and Address of
Employer:
Position Held:
Supervisor Name:
Wages:
From:
To:
Reason for Leaving:
Dates:
From
To
Month
Year
Month
Year
Name and Address of
Employer:
Position Held:
Supervisor Name:
Wages:
From:
To:
Reason for Leaving:
Dates:
From
To
Month
Year
Month
Year
Name and Address of
Employer:
Position Held:
Supervisor Name:
Wages:
From:
To:
Reason for Leaving:
May we contact your
current employer?
Yes
No
Personal
References
Provide names of 2 people, not related to you
Name:
Address (street, city,
state, zip):
Phone Number:
How acquainted and how
long?
Name:
Address (street, city,
state, zip):
Phone Number:
How acquainted and how
long?
Education
School
Name and Location of School
# of years completed
Degree?
Type of Course/Major
Highschool
Yes
No
College/University
Yes
No
Additional Training
Yes
No
Academic
and Professional Activities
List
academic and professional activities and achievements, awards,
publications or technical-professional societies. Exclude
organizations that indicate race, creed, color, age, sex,
religion, disability or national origin of its members.
Other
Information
In
answering the questions below, do not include information
regarding an arrest or detention that did not result in
conviction, information regarding a referral to, and participation
in, any pre-trial or post-trial diversion program, minor traffic
violations, convictions for which the record has been judicially
ordered sealed or expunged or misdemeanor convictions for which
probation has been successfully completed or discharged and that
have been judicially dismissed. Conviction of a crime, or pleading
guilty to a criminal charge, will not necessarily disqualify you
from the job for which you are applying. Each conviction or plea
will be considered with respect to time, job relatedness, and
other relevant factors.
Have you ever pleaded
“guilty” or “no contest” to, or been convicted of, a
misdemeanor or felony?
Yes
No
Please provide the
details, including dates and locations:
Agreement
I certify that
all of the information that I have supplied on this application is
true and complete to the best of my knowledge and that I have not
knowingly withheld any information, which, if known to the
Company, would affect my application unfavorably. I understand
that any false, misleading and/or incomplete statements on this
application and/or in any interview constitute sufficient cause
for the Company not to employ me, or if I am employed, to
terminate my employment.
I understand and agree that if I am hired in any
capacity, my employment is at-will and my employment and
compensation can be terminated with or without cause or notice at
any time at the option of the Company or me. I also understand
that no Company representative has any authority to enter into any
agreement for employment for a specific period of time, to assure
any benefits or terms and conditions of employment, or to make any
agreement contrary to the foregoing.
I authorize investigation of all the information I
have supplied on this application and all other information, which
the Company deems to be relevant to my qualification for
employment. I understand that if an investigative report is
requested from a consumer reporting agency, I have the right to
make a written request within a reasonable period of time for a
complete and accurate disclosure of the nature and scope of the
investigation requested. I release the Company and all other
persons from any and all liability for any damage that may result
from the information being furnished to the Company.
I agree to take any lawful examination or test,
including any drug test, required by the Company as a condition of
my being hired, or I am hired, as a condition of my continued
employment. I further agree that my refusal to take any such
lawful examination or test will constitute sufficient cause for
the Company not to employ me, or if I am employed, to terminate my
employment. I release the Company and all others from any and all
liability for any damage that may result from any lawful
examination or test. If I am employed, I agree that in
consideration for my employment, I will conform to the regulations
of the Company, I understand that those rules and regulations may
be amended or repealed at any time, at the Company's sole option
and without prior notice to employees.
I
accept the terms of this agreement
Date: 05/07/2007
The Oasis Family Fun Center is an Equal Opportunity
Employer and offers equal employment opportunity to all persons
without regard to race, color, age, religion, sex, sexual
orientation, ancestry, national origin, disability, marital status
or veteran status. Federal, state and local laws prohibit these
and other forms of discrimination and it is our policy to comply
with these laws and the information requested on this application
will not be used for any purpose prohibited by law. Your
application will be considered active for 30 days. For
consideration after that, you must reapply.
