On-Line Application For Employment

 Date:

Personal Information
Name: First: Middle Last
Street Address
City State Zip Age
How Long Have You Lived At This Address?

(Required if under age 19)
Telephone Cell # E-mail

Emergency Contact Information
Name: Telephone
Address City State Zip

Education:
High School Graduated
Honors or Awards Received
College Degree
Honors or Awards Received
Additional Comments
Do You Attend School Now? If So, What School? Current Grade
Current Field of Study Projected Date of Graduation

Position Applying For: Date Available To Start Work
  Full Time Part Time Summer Only Seasonal - Full Time Seasonal - Part Time
Are you willing to work overtime if needed? Yes   No

 Are you willing to work weekends if needed?

 Yes   No

Previous Employment
List the Last 3 Jobs That You Have Held (Current or most recent job first)
Name Start Date Starting Pay Rate
Address
City, State, Zip End Date Ending Pay Rate
Job Title
Job Description
Reason for
Leaving:
Supervisor Phone

Previous Employment
List the Last 3 Jobs That You Have Held (Current or most recent job first)
Name Start Date Starting Pay Rate
Address
City, State, Zip End Date Ending Pay Rate
Job Title
Job
Description
Reason for
Leaving:
Supervisor Phone

Previous Employment
List the Last 3 Jobs That You Have Held (Current or most recent job first)
Name Start Date Starting Pay Rate
Address
City, State, Zip End Date Ending Pay Rate
Job Title
Job
Description
Reason for
Leaving:
Supervisor Phone

Have you ever been arrested for a felony? Yes No If yes, please explain
Do you have any physical or mental ailment, illness, sickness, disease or condition? Yes No If yes, please explain
Do you have any physical or medical restrictions on performing work? Yes No If yes, please explain

Vande Walle's Candies retail store is open the following hours:
Mon
7 am - 9 pm		 Tue
7 am - 9 pm		 Wed
7 am - 9 pm		 Thur
7 am - 9 pm		 Fri
7 am - 9 pm		 Sat
7 am - 9 pm		 Sun
10 am - 6 pm
If you are applying for a retail sales position, please fill in on the following chart the hours that you are available for work on each of the days:
  Mon Tue Wed Thur Fri Sat Sun
From
To

CHARACTER REFERENCES (do not list relatives or past or current employers)
Name & Address,
and Telephone #		 Relationship
To You
How Long have You
Known This Person?
Name & Address,
and Telephone #		 Relationship
To You
How Long have You
Known This Person?
Name & Address,
and Telephone #		 Relationship
To You
How Long have You
Known This Person?

Please list any community organizations that you are involved with:
Why do you want to work at Vande Walle's Candies?
What qualities or characteristics do you possess that would be
beneficial to employment at Vande Walle's Candies?
By submitting this application, I hereby authorize investigation of all statements contained in this application. I understand that any intentional or unintentional misrepresentation or omission of facts called for on this application is just cause for dismissal.
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