Employment Application Equal Opportunity Employer – Drug Free WorkplacePlease complete all required fields and submit your application to be considered for a job position. First MIddle Last Address City State ZIP Code Email Address Phone Alternate Phone You want to work: Full Time Part-Time Temporary Hours per week desired Position you are applying for Have you ever applied before? Yes No If YES, when? Salary Desired (per hour) Desired Start Date Do you personally know anyone who is employed here? Yes No If YES, who do you know that is currently employed here? Are you currently employed elsewhere? Yes No If YES, do you intend to keep that job? Yes No If hired, can you provide documents that prove your identity? Yes No If hired, can you present documentation that you are legally authorized to work in the United States? Yes No If hired, are you willing to submit and pass a controlled substance test? Yes No Have you ever been convicted of or pleaded guilty to a crime? No Yes Our Business Hours Monday 6am-3pm, Tuesday - Friday 6am-7pm, Saturday 6am-3pm, Sunday 7am-3pm. Sunday Time-In Sunday Time-Out Monday Time-In Monday Time-Out Tuesday Time-In Tuesday Time-Out Wednesday Time-In Wednesday Time-Out Thursday Time-In Thursday Time-Out Friday Time-In Friday Time-Out Saturday Time-In Saturday Time-Out Do you feel you will be able to be flexible with your scheduling? (nights, weekends, holidays?) Yes No Do you have a reliable form of transportation that will allow you to arrive to work at scheduled times? Yes No Do you have anything upcoming that would require you have 3 days off in a row? No Yes If YES, describe: Do you have any experience with Future Computer Systems, or any computerized system used for order placement? Yes No If hired, are you able to perform the essential functions of the jobs for which you are applying either with/without reasonable accommodations? Yes No If NO, please explain: Have you ever been terminated from a job? No Yes If YES, how many? Are you currently, or do you plan to be, in school or taking any course while working here? Yes No FORMER EMPLOYERS LIST BELOW THE LAST 3 EMPLOYERS STARTING WITH THE MOST RECENT FIRST) Current Employer Current Position Date Start Date End Did you handle cash? Yes No Reason for leaving Name and title of supervisor Phone number of supervisor Previous Employer 1 Previous Position 1 Date Start Date End Did you handle cash? Yes No Reason for leaving Name and title of supervisor Phone number of supervisor Previous Employer 2 Previous Position 2 Date Start Date End Did you handle cash? Yes No Phone number of supervisor Name and title of supervisor Reason for leaving Consent I certify that the facts contained in this application are true and complete. I hereby certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time , or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. Send