COME BACK SHACK
APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
PERSONAL (Please Print)
Name:___________________________________________________________ Date:___________________________________
Address:_______________________________________________________
Telephone: (
) _______________________________
If you are under 18 years of age, please provide date of birth
Are you legally eligible for employment in this country?
email:___________________________________
Social Security Number:_______________________________
_______-________-________
Yes
No
SPECIAL SKILLS OR TRAINING (applicable to employment)
EMPLOYMENT HISTORY (starting with most recent)
Employer:
Phone: __________________________________
Address: _______________________________________________________________________________________________
To: ________________ From:______________ May we contact your employer?___________________________
Supervisor: ____________________________________________________
Job Title and Description of Job Duties:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Reason for Leaving:
Starting Salary:
Ending Salary:
Employer:
Phone: __________________________________
Address: _______________________________________________________________________________________________
To: ________________ From:______________ May we contact your employer?___________________________
Supervisor: ___________________________________________________
Job Title and Description of Job Duties:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Reason for Leaving:
Starting Salary:
Ending Salary:
EDUCATION
NAME AND LOCATION
High School
College
Other
FROM
TO
DEGREE/MAJOR
GRADUATED
AVAILABILITY (List hours available to work per week below) # of shifts______# of hours______
Monday
Tuesday
Wednesday
Thursday Friday Saturday
From To From To From To
From To
From To From To
Sunday
From To
ADDITIONAL DATA
RATE OF PAYDESIRED?_____________________________________DATE AVAILABLE:_____________________________
HOW DID YOU HEAR ABOUT THIS JOB?_____________________________________________________________________
LIST ANY FRIENDS OR RELATIVES WORKING WITH US_______________________________________________________
HAVE YOU EVER BEEN CONVICTED OF A FELONY IN THE LAST SEVEN(7) YEARS?_____________________________
(Conviction will not automatically disqualify an applicant from employment.)
IF YES PLEASE EXPLAIN___________________________________________________________________________________
__________________________________________________________________________________________________________
WHAT DO YOU WANT OR HOPE TO CONTRIBUTE TO COME BACK SHACK? _________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
WHAT PERSONAL EXPECTATIONS DO YOU HAVE THAT COME BACK SHACK NEEDS TO MEET?
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
REFERENCES
List only persons we can contact (Be sure to include phone numbers)
Name
Address
Relationship
Phone________
1.
_________________________________________________________________________________________
2.
_________________________________________________________________________________________
3.
The information provided by me in this application for employment is true and complete to the best of my knowledge. I understand
that if I am employed, any false statement will be considered as cause for possible dismissal. Employment with COME BACK
SHACK is at-will and may be terminated by either the company or the team member at any time. Written or oral statements made to
the team member are not to be interpreted in any way that alters the at-will relationship.
APPLICANT SIGNATURE _____________________________________ DATE ______________________________
FOR EMPLOYER USE ONLY – APPLICANT DO NOT WRITE IN THIS SECTION
Interviewed ______yes_______no
Interviewer: ____________________Date________________
Remarks/Notes:_______________________________________________________________________________________________
____________________________________________________________________________________________________________
Employed: _______yes _______no
Job Title:________________________________________
Employment Date:______________Rate of Pay_______________
Job Status: FT PT Regular Temp
Hiring Supervisor:__________________________________________________Date__________________