S&M Family Outlet

S & M Family Outlet

| S&M Family Outlet

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, or veteran status, or any other legally protected status.

Position(s) Applied For	Date of Application
How Did You Learn About Us?

Last Name	First Name	Middle Name
Address	City	State	Zip Code
Telephone Number(s)	E-mail Address	Social Security Number --

If you are under 18 years of age, can you provide required proof of eligibility to work?

Have you ever filed an application with us before?
	If Yes, give date

Have you ever been employed with us before?
	If Yes, give date

Are you currently employed?

May we contact your present employer?

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status
Proof of citizenship or immigration status will be required upon employment

On what date would you be available for work?

Are you available to work:

Are you currently on "lay-off" status and subject to recall?

Can you travel if a job requires it?

Have you ever been convicted of a criminal offense?
List year, charge and outcome
Have you ever pled guilty or nolo contendere (no contest) to a criminal charge in order to qualify for deferred adjudication?
List year, charge and outcome
Have you ever been on any type of probation as a result of a criminal charge?
List year, charge and outcome

NOTE: Convictions, guilty or no contest pleas, or probation WILL NOT necessarily disqualify an applicant from consideration.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected statues.

1.	Employer		Dates Employed		Work Performed
			From	To
	Address
	Telephone Number(s)		Hourly Rate/Salary
			Starting	Final
	Job Title	Supervisor
	Reason for Leaving

2.	Employer		Dates Employed		Work Performed
			From	To
	Address
	Telephone Number(s)		Hourly Rate/Salary
			Starting	Final
	Job Title	Supervisor
	Reason for Leaving

3.	Employer		Dates Employed		Work Performed
			From	To
	Address
	Telephone Number(s)		Hourly Rate/Salary
			Starting	Final
	Job Title	Supervisor
	Reason for Leaving

4.	Employer		Dates Employed		Work Performed
			From	To
	Address
	Telephone Number(s)		Hourly Rate/Salary
			Starting	Final
	Job Title	Supervisor
	Reason for Leaving

Check this box if there is more work history than you can fit on this application

List Professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status:

References

1.	Name:	Phone:
	Address:

2.	Name:	Phone:
	Address:

3.	Name:	Phone:
	Address:

Specialized Skills

Note to applicants: Do not answer this question unless you have been informed about the requirements of the job for which you are applying.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation the activities involved in the job or occupation for which you have applied? A description of the activities in such a job or occupation is elsewhere on this website.

Check Skills/Equipment Operated

Education

		Course of Study:	Years Completed:	Diploma/Degrees:
Elementary School	Name:
	Address:
High School	Name:
	Address:
Undergraduate College	Name:
	Address:
Graduate Professional	Name:
	Address:
Other (Specify)	Name:
	Address:

Describe any specialized training, apprenticeship, skills and extra-curricular activites

Describe an job related training received in the United States military

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed six months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may be be change by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all policies, procedures, rules and regulations of the employer.

If employment is offered, I understand that it is temporary until all information is verified, and that misstatement or omission of fact shall result in immediate dismissal.

I authorize the Company to investigate my past employment, medical history, educational background, credit history, involvement in prior litigations, criminal history and driving records. I hereby release from liability and hold harmless the Company, any of its subsidiaries and any contributing firm, individual, organization or governmental agency or records depository and all of their officers, employees and agents.

I specifically authorize the release of all available personal information, data and records from the following sources: former employers, individuals, United States district courts; city county and state district courts, industrial accident boards state attorney general's office, department of public safety (state police), educational institutions, federal bureaus and credit reporting agencies,

I understand that any inaccurate information provided about me shall not be the responsibility of Company and that sole responsibility shall be attributed to the reported agency.

I further authorize use of breathalyzer and/or collection of my urine to determine the use of alcohol, drugs or controlled substances. In addition, I authorize the release of this information to the authorized individual at Company.

I understand that the above sources will be utilized to determine my employability and I have carefully read and agree to all of the foregoing. I certify that all of the information provided by me on my employment application is true and complete.

Applicant's Initials

Date