Gasser

Employment Application

Applications must be submitted to be considered for employment

Personal Information
First Name:Middle Name:Last Name:

Address:  

City:    State:    Zip:

Phone: Email:

If you are under 18, please enter your date of birth:

Type of employment you are seeking: Full time Part time (< 40 hours/week)

Position/general work area for which you are applying:

If hired, when can you begin work?  

Explain any restrictions on hours, weekends, overtime:

Which location would you be interested in working at:

Are you eligible to work in the USA? Yes No

What prompted you to apply at our company? (Please check one)

History
School Name & AddressYears
Attended		GraduatedCourse of Study
High School
Business, Trade or Vo-Tech
College

If in school now, please indicate class schedule including times:

Have you been convicted of a felony? No
Yes -- Please Explain:
Convictions will not automatically disqualify applicants but will be considered only if they are substantially related to emplyoment.

Have you been previously employed by Gasser Hardware Company?

If yes: Date of previous employment:
What was the store location?
Why did you leave?

Most Recent Employment
Company 1

Company Name:

Address:    Telephone:

Position:    Supervisor:

Dates worked:  From to    Wage:

Reason for leaving:


Company 2

Company Name:

Address:    Telephone:

Position:    Supervisor:

Dates worked:  From to    Wage:

Reason for leaving:


Company 3

Company Name:

Address:    Telephone:

Position:    Supervisor:

Dates worked:  From to    Wage:

Reason for leaving:


Please Read

I certify that all the information on this application, my resume, or any supporting documents is correct. I understand that any misrepresentation or omission of any information will result in disqualification from consideration for employment or, if employed, my termination. I understand this application is current for one hundred eighty (180) days. After this time, if I have not heard from the Company and still wish to be considered for employment it will be necessary for me to complete a new application. I understand that this application is not a contract, offer or promise of employment. If hired, I am able to resign at any time for any reason. Similarly, the Company can terminate my employment at any time, with or without any reason.

I authorize the Company or its agents to investigate all statements contained in this application and/or resume. I hereby authorize my former employers, educational institutions or other reference providers to furnish all information pertaining to my work or educational record. I release my former employers, educational institutions, supervisors, and references from all liability associated with furnishing information to this company or its agents. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations or organizations for furnishing such information.

This organization is an equal opportunity employer which does not discriminate on the basis of race, religion, color, gender, age, national origin, disability, marital status, or veteran status or similar as identified in legal and regulatory guidelines.

Reasonable accomodations may be provided to qualified individuals with disabilities in accordance with the Americans with Disibilities Act (ADA) and applicable state and local laws.

If nessesary, you will be contacted by a Human Resources representitive to obtain your Social Security number and Drivers License number.

Date of Application: 09/04/2010

Name as it appears on your Social Security Card:

Background Investigation required as a condition of employment. EOE.