Ready. Set. Apply! Employment ApplicationUse the form below to inquire about employment opportunities with our company. First Name * Middle Name Last Name * Email * Phone * (###) ### #### Street Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Do you have the legal right to live and work in the U.S.? * Yes No Names of friends or relatives employed in this organization Have you ever applied to this organization before? * Yes No Do you have any family, business, health, or social restrictions or obligations that would prevent you from performing the job responsibilities? * Yes No Do you have any physical or mental condition or handicap which would endanger the health or safety of yourself and or others or that may affect your ability to perform the job(s) for which you are applying? * Yes No Have you ever been convicted of a felony? * Yes No Employment Interests Position(s) Desired or Area of Interest: * Front of House Specialist Cellular Repair Tech Computer Repair Tech Which location are you applying for? * Alexandria, LA Lafayette, LA Date available to start? * MM DD YYYY Type of employment you are seeking: * Part Time Full Time Temporary Why should we hire you for this position? * Desired Pay Per Hour * $ How will you get to work? (Type of transportation) Education/U.S. Military Service School/College Background (New line for each school) Are you taking any educational courses presently? Yes No I will be soon If you answered "Yes" or "I will be soon" please explain. Have you ever served in the U.S. Armed Services? * Yes No References List 3 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. Reference #1 Reference #2 Reference #3 Employment History Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work. Company #1 (Most Recent) Company Name Street Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Start Date MM DD YYYY End Date MM DD YYYY Job Title Supervisor's Name & Title Company Website http:// Starting rate of pay $ End rate of pay $ Description of duties Reason for leaving May we contact this employer? Yes No Company #2 Company Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Start Date MM DD YYYY End Date MM DD YYYY Job Title Supervisors Name and Title Company Website http:// Start Rate of Pay $ End Rate of Pay $ Description of duties Reason for leaving May we contact this employer? Yes No Company #3 Company Name Street Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Start Date MM DD YYYY End Date MM DD YYYY Job Title Supervisors name and title Company Website http:// Starting Rate of Pay $ End Rate of Pay $ Description of duties Reason for leaving May we contact this employer Yes No I agree to a drug screening at the company's expense * Yes No I agree to a Criminal Background Check at the company's expense. * Yes No Acknowledgement I hereby certify that the information contained in the employment application I submit to Apple Pie Repair is true and complete to the best of my knowledge. I understand that material omissions or falsification of this application in any detail may result in my disqualification from consideration for employment or for dismissal from employment. Digital Signature * Printing your First Name + Middle Initial + Last Name will act as your digital signature. Thank you!
