EMPLOYMENT
APPLICATION
Rev. 6/14
Please provide complete and legible information. An incomplete application may affect your consideration for employment. “Herb” Philipson’s is an
equal opportunity employer committed to a policy of nondiscrimination with respect to race, color, sex, national origin and any other class protected by
federal or state law, including, but not limited to medical condition, disability, marital status, age, sexual orientation or pregnancy.
(PLEASE PRINT) Last Name
First Name (as
Middle
Initial
shown on I-9 document)
Street Address
Today’s Date
Telephone
(
City, State and Zip Code
Email Address
Have you been employed by
“Herb” Philipson’s in the past?
YES
If “YES” give location
)
Alternate Telephone or Cell
(
Position and Year
)
Name at the time of employment (if different)
NO
Have you applied for Employment with
“Herb” Philipson’s before?
YES
List any relatives employed at “Herb” Philipson’s and their relationship to you:
NO
Indicate highest level of school completed:
grade school
high school
trade school
Name and location of last (or current) school: ___________________________________________
2 yr. College
4 yr College
Earned Degree: _________________
Please check below any departments or positions you would like to be considered for:
DISTRIBUTION CENTER
(Oneida Area Only)
RETAIL STORES
Sales Associate
Cashier
Management
Loss Prevention
Price Marker
Truck Driver
Administrative
Maintenance/Stock
Other ____________________________
CORPORATE OFFICE
(Rome Only)
Accounting
Management
Administrative
Buying Dept.
Operations
Merchandise Handler
Tech Support
Merchandising
Other: _________________________
Other: __________________________
Please use the space on the second page to indicate any
Are you eligible/authorized to work in the
outside interests, hobbies or training you voluntarily want
Are you 18 years of age or older?
United States?
to share that add to your knowledge or abilities in any
aspect of our business (ex: hunting, camping, leadership
YES
NO
YES
NO
training, etc.)
*If “yes”, on a separate sheet, identify the crime for which you were convicted,
Have you ever been
Have you ever been convicted of any
the date of the conviction and the location of the court in which you were
convicted of a felony?*
type of theft, fraud or violent crime?*
convicted. Please provide any details you feel are relevant. Conviction of a
crime will not automatically disqualify you from consideration for employment,
YES
NO
YES
NO
but will be considered as part of an overall evaluation of your qualifications.
Please check all locations you are available to work at:
Herkimer
Watertown
YOUR AVAILABILITY*:
Liverpool
SUNDAY
Distribution Center
Western Lights
MONDAY
TUESDAY
Newark
Rome
New Hartford
Oneida
OTHER: _________________________________
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Earliest Time
Latest Time
*Note: availability is HEAVILY considered in the employment decision. Be sure to include all limitations and available time.
Expected rate of pay: ___________ First date available: _________ Prefer
NOTE: Limited Full Time Positions are available.
Full Time
Part Time
If you will accept a position with less than 30 hours please check here
If your availability will change in the next 3 months please explain: ________________________________________________
Please indicate your referral source:
Store Sign
Newspaper
Person
Dept of Labor
If the person who referred you to “Herb”
Philipson’s is a current employee,
please write first and last name here
OTHER
EMPLOYMENT HISTORY: Starting with your most recent employment, complete all information for each position held.
Do not om it any places of e m ploym ent. Do not write “see resume”. Use additional paper if
necessary.
Company
Name:
Supervisor:
Address:
Telephone
No.
(
)
Rate
of pay:
Employed
from:
To:
Reason for
Leaving:
Your Job:
Company
Name:
__ Voluntary
__ Involuntary
Supervisor:
Address:
Telephone
No.
(
)
Rate
of pay:
Employed
from:
To:
Reason for
Leaving:
Your Job:
Company
Name:
__ Voluntary
__ Involuntary
Supervisor:
Address:
Telephone
No.
(
)
Rate
of pay:
Employed
from:
To:
Reason for
Leaving:
Your Job:
__ Voluntary
__ Involuntary
Please use this space to indicate any outside interests, hobbies or training you voluntarily want to share that add to your knowledge or abilities in any
aspect of our business (ex: hunting, camping, leadership training, etc.):
List two people you have worked with (non-relatives) and who we may contact for a reference if necessary.
Name:
Place of Employment:
Telephone:
Name:
Place of Employment:
Telephone:
APPLICANT'S STATEMENT I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any
time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is
specifically authorized in writing by the chief operating officer of this organization. I understand that this application is not a contract of employment. I understand
that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure
to submit such proof will result in denial of employment. I certify that all the statements herein are true and understand that any falsification or willful omission shall
be sufficient cause for dismissal or refusal of employment.
Date of Application:
Mailing
Instructions:
“Herb” Philipson’s Army & Navy Stores
Attn: Human Resources Dept.
1899 Black River Blvd., Rome, NY 13440
Email: hr@herbphilipsons.com
Signature:
Apply In Person at:
-232 West Albany Street, Herkimer, NY 13350
-Glenwood Plaza, One Glenwood Ave., Oneida, NY 13421
-New Hartford Shopping Center, New Hartford, NY 13413
-The Plaza at Black River ,1899 Black River Blvd., Rome, NY 13440
-1283 Arsenal Street, (Price Chopper Plaza), Watertown, NY 13601
-Glenn Crossing Plaza, 7421 Oswego Rd, Liverpool, NY 13090
- Western Lights Plaza: 4713 Onondaga Blvd. Syracuse, NY 13219
- 6708 Route 31, Newark, NY 14513