Geisslers Employment Form

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Geisslers Employment Application

An Equal Opportunity Employer

Date 8/20/2008

Personal Information

First Name*

Last Name*

Phone*

Email*

Street Address*

Apartment

City*

State, Zip*

Personal Questions

Question 1*

Yes No

Have you ever worked for Geissler's in the past?

Question 2*

Yes No

Are you currently Employed?

Question 3

Yes No

Are you either a U.S. citizen or an Alien with unrestricted authorization to work in the United States?

Question 4*

Yes No

Have you ever been convicted of or charged with a felony or misdemeanor?

Work Amount Desired

Full Time Part Time Temporary / Seasonal

Position Desired
Position Desired
Alternate
Alternate

Location Desired
Location Desired
Alternate
Alternate

Availability
Weekday	Specific Times
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Age
Select Your Age

Wage Desired
Wage Desired
Wage Per

Education: Schools, Colleges & Other Training (List In Order Of Completion)

High School

Name Years Complete

Graduated/Completed Yes No Attending

College

Name Years Complete

Graduated/Completed Yes No Attending

Other 1

Name Years Complete

Graduated/Completed Yes No Attending

Employment History (List Most Recent First)

Employer 1

Employer

Last Position

Supervisor

Street Address

City

State Zip

Phone

Ending Pay

Employed From To Reason For Leaving

Duties & Responsibilities

Employer 2

Employer

Last Position

Supervisor

Street Address

City

State Zip

Phone

Ending Pay

Employed From To Reason For Leaving

Duties & Responsibilities

Employer 3

Employer

Last Position

Supervisor

Street Address

City

State Zip

Phone

Ending Pay

Employed From To Reason For Leaving

Duties & Responsibilities

Personal or Business References (List Most Recent First)

Reference 1

Name

Company

Position

Street Address

City

State Zip

Phone

I know this person as a
Supervisor Co-Worker Friend Other

Reference 2

Name

Company

Position

Street Address

City

State Zip

Phone

I know this person as a
Supervisor Co-Worker Friend Other

Reference 3

Name

Company

Position

Street Address

City

State Zip

Phone

I know this person as a
Supervisor Co-Worker Friend Other

Special Skills & Qualifications

Describe any special skills or qualifications for this position.

Policy & Application Agreement

I CERTIFY that the above answers are true and complete to the best of my knowledge. I authorize Geisslers, to investigate any statement contained in this application, and to obtain a credit report on me (and my company if this application is for reselling by a company) as necessary to determine my qualifications. I understand that this application is not and is not intended to be any kind of contract or agreement. In the event of employment, I understand that any false or misleading information given in my application, correspondence, discussions or interview may result in immediate termination. I understand that I am required to abide by all rules, regulations and policies of Geisslers.

I Agree I Do Not Agree *

Submit Your Application

You can submit your completed application to us electronically by clicking the Submit Button below, or if you prefer you can click the Print Button to view a printer friendly version of your completed application.