Employment Application 1 Personal Info2 Education Info3 Employment Info4 Physical Info5 Terms of Service Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email Address Enter Email Confirm Email Are you 18 years or older?*YesNoAre you a U.S. Citizen?*YesNoHave you been convicted of a felony or misdemeanor?*YesNoIf so, please explain:*Disclaimer*I understand that I will not be denied employment solely because of a conviction record unless the offense is related to the job for which I am applying. EducationList Your Schools*SchoolLocationYears AttendedGraduated Please list any high school, college, or technical schools you have attended. Click the "+" button to add more.List Your Degrees and CertificationsAre you currently a member of the National Guard or Reserve?*YesNo Employment InformationPosition(s) Desired*Which locations would you like to apply for?* Collegeville store Little Liberty store (In Collegeville) Pottstown store Quakertown store Sanatoga store Wage/Salary Desired*Date Available Which do you prefer?* Full Time Part Time Current EmploymentAre you currently employed?*YesNoIf yes, where?May we inquire of your present employer?*YesNoReferencesWork References*Name of EmployerAddressDates EmployedPositionHourly WageReason Left Beginning with current, please list your last four employers. Click the "+" button to add more references. If this would be your first job, please write n/a in the fields.Personal References*NameAddressDay PhoneNight Phone Please list at least three people not related to you who could give a personal reference. At least one person should be able to relate to past employment. Physical InformationAbility To Complete Work*I am able to complete all functions as outlined in the job description.I am able to complete all functions as outlined in the job description with the following adjustments or accommodations:Please explain:Emergency InfoIn case of emergency, notify:NameRelationshipAddressDay PhoneNight Phone I certify that the facts contained in this application are true and complete to the best of my knowledge. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that if hired, my employment is for no definite period and, regardless of the date of payment of my wages and salary, may be terminated at any time without prior notice.Date*Signature*This form has been designed to comply with State and Federal Fair Employment Practice laws prohibiting employment discrimination.NameThis field is for validation purposes and should be left unchanged.