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Employment Application
Career Opportunity: Application Form
Application for Employment:
So that we might serve you more effectively, please enter your contact information below:
Contact Information:
*
Full Name:
Street Address:
State:
City:
Zip:
*
Cell Phone:
*
Email:
*
Required Fields
General Information:
If hired, you may be required to submit proof of your age.
Are you 18 years old or older? Yes:
No:
Do you have a valid Driver’s License? Yes:
No:
License #
State driver's license issued?
CDL? Yes:
No:
If so, CDL type:
Has your License been revoked or suspended in the last three years? Yes:
No:
If so, please give a short explanation:
Education
Highest degree earned:
Major:
Minor:
Please explain awards & accomplishments:
Recent Employment History
1st Company Reference
Length of Time Employed:
From:
To:
Pay:
From:
$
Per:
To:
$
Per:
What was your Position/Title?
Supervisor's Name and Title?
Explain duties performed & accomplishments at this company:
Please explain your reasons for leaving:
Company Name:
State:
Phone (including area code):
2nd Company Reference
Length of Time Employed:
From:
To:
Pay:
From:
$
Per:
To:
$
Per:
What was your Position/Title?
Supervisor's Name and Title?
Explain duties performed & accomplishments at this company:
Please explain your reasons for leaving:
Company Name:
State:
Phone (including area code):
3rd Company Reference
Length of Time Employed:
From:
To:
Pay:
From:
$
Per:
To:
$
Per:
What was your Position/Title?
Supervisor's Name and Title?
Explain duties performed & accomplishments at this company:
Please explain your reasons for leaving:
Company Name:
State:
Phone (including area code):
Personal Reference/Special Knowledge and Skills
List a Personal Reference:
Name:
Relationship:
Phone:
List any specialized knowledge or skills which you bring to your job:
Have you ever been convicted of a Misdemeanor or Felony?
Yes:
No:
If yes, please give a brief explanation of the incident:
(You may be asked for further explanation at a later time.)
Please Read Background Check/Consent Policy
:
*
I have read
ValuPlus Merchants Association Background Check & Consent Policy
and I understand and agree to the terms and conditions thereof.
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