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Application for Employment - An equal opportunity employer

Today's Date:

YYYY

Name:

First Name

Last Name

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number:

(###)

###

####

Email Address:

Social Security Number:

Location you are applying for:

Ace Hardware Midway

Ace Hardware Midway Tool Shop

Ace Hardware Hammonds

Ace Hardware Hwy 20

Date Available:

YYYY

Desired Position:

Do you wish to work:

Please indicate hours you are available to work:

Education

High School

Name and location:

# of Years Attended:

Do you have a diploma or GED?

Yes

I'm still in high school

College

Name and location:

# of Years Attended:

Major Course(s):

Do you have a college degree? If so, what is it for?

Graduate School

Name and location:

# of Years Attended:

Do you have a graduate degree? If so, what is it for?

Other type of education

Name and location:

# of Years Attended:

Please explain what the education was for and if you completed the program:

Skills

Check all that apply:

POS Machine

Key Cutting Machine

Paint Mixing Machine

Word Processing

Electrical

Plumbing

Building Construction

Personal Computer

Employment History

Give names and addresses of all previous employers. If you are currently employed, present employer and reason for desire to quit must be included. Additional paper will be provided upon request. Also give reason for any lapse of time between jobs.

May we contact your current employer?

Yes

Employer:

List most recent employer first:

Employer Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dates Employed - Start Date:

YYYY

Dates Employed - End Date (If Applicable):

YYYY

Earnings History:

Starting Wage - Final Wage

Title:

Duties:

Reason for Leaving / Reason for Desire to Leave:

Employer:

List second most recent employer:

Employer Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dates Employed - Start Date:

YYYY

Dates Employed - End Date:

YYYY

Earnings History:

Starting Wage - Final Wage

Title:

Duties:

Reason for Leaving:

Military service

Military Branch:

Final Rank/Grade:

Type of Discharge:

Reserve Status:

General Information

Have you ever been employed by our Company?

Yes

If yes, provide the the dates of your employment and the location:

Do you have any relatives currently employed by our Company?

Yes

If yes, please state the person's name, job and employment location:

Have you ever been convicted or pleaded guilty to a felony?

Yes

If yes, please give full details below - conviction won't necessarily disqualify you for the position for which you are applying.

Have you ever been arrested?

Yes

If yes, give full details:

Have you ever been fired from employment?

Yes

If yes, give full details:If

If hired, can you furnish proof of age?

Yes

If hired, can you furnish proof you are legally entitled to work in the U.S.?

Yes

How did you hear about our Company?

If applicable, what employee or agency referred you to us?

Are there any other experiences, skills, or qualifications which you feel would especially fit you for work with our Company? If so, please explain:

References

#1. Reference Name:

Phone Number:

(###)

###

####

Relationship to Applicant:

#2. Reference Name:

Phone Number:

(###)

###

####

Relationship to Applicant:

#3. Reference Name:

Phone Number:

(###)

###

####

Relationship to Applicant:

#4. Reference Name:

Phone Number:

(###)

###

####

Relationship to Applicant:

Please read the following carefully before signing below:

I certify that the information contained in this application and/or any supplement thereto, is correct to the best of my knowledge and understand that any mis-statement or omission of information is grounds for dismissal in accordance with Company Policy. I authorize Ace Hardware to contact my current or prior employers and/or the above references and request any information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I expressly release Ace Hardware and all parties providing such information from any and all liability or responsibility for damage that may result from furnishing the same to you. I further understand said background check may also involve the Company’s obtaining an investigative consumer report on me which may cover such areas as my character, general reputation and mode of living. I hereby authorize the Company, if they wish, to make such an inquiry and understand that upon my written request, additional information as to the nature of said inquiry will be provided. If I am offered a position with the Company, I agree to conform to the applicable rules, regulations and policies of the Company, and acknowledge that my employment and compensation can be terminated at any time with or without cause, and with or without notice, at the option of either the Company or myself. I further understand that no representative of the Company has any authority to make any agreement contrary to the foregoing or to bind the Company for the employment of any person for any specified period of time.

Applicant's Electronic Signature:

This applicant is considered current for 90 days. if you want to be considered for employment after this time you must renew your application in writing. You must fill in your own application and fully complete this application in order to receive proper consideration.

Today's Date:

YYYY

Thank you! You application has been received. A store representative will reach out to you to schedule an interview if we think you will be a good addition to our team.

Ace Hardware Forsyth