Agata & Valentina Employment Application
Location:   StoreDate   19.06 18Position Desired  
Name   Last: First: Middle:
Salary Desired    Date Available To Start
I am interested in:   Full Time  
  35+ hrs./wk.
  Part Time  
  0-34 hrs./wk.
  Seasonal 
35+ hrs. /wk.
  Summer/Holiday
Street Address  City  State    Zip Code 
Are you at least 18 years old?    Yes No  
Agata & Valentina is required to comply with Federal, State, or Local Law.
Telephone Number: Daytime  Evening  Cell 
Email    Best time to be reached 
Has a relative, friend, or acquaintance of yours ever worked with our company?   Yes No  
If yes, Name:  Position  Relationship  Date  
Have you ever applied to our company before? Yes No  If yes, When?    Position   
If you have worked for our company before, state when, final position, and reason for leaving.
Availability
Please indicate the hours you are available to work both day and evening (example - Wed. 3pm-12am).
SundayMondayTuesdayWednesdayThursdayFridaySaturday
Specify Times Available
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Work Experience
List employers starting with the most recent one. Please include any non-aid/volunteer experience which is related to the job for which you are applying for.
Please complete all information even if you attach a resume.
From: (mm/yy) To: (mm/yy) Employer Name:Phone:
Address
Position:   Supervisor's Name  
Wages:   StartingFinal
Reason For Leaving:
From: (mm/yy) To: (mm/yy) Employer Name:Phone:
Address
Position:   Supervisor's Name  
Wages:   StartingFinal
Reason For Leaving:
From: (mm/yy) To: (mm/yy) Employer Name:Phone:
Address
Position:   Supervisor's Name  
Wages:   StartingFinal
Reason For Leaving:
From: (mm/yy) To: (mm/yy) Employer Name:Phone:
Address
Position:   Supervisor's Name  
Wages:   StartingFinal
Reason For Leaving:
Are you presently employed?   Yes No  May we contact your current employer?   Yes No  
Employment References
Employer  Reference's Name  Title  Phone  
Employer  Reference's Name  Title  Phone  
Employer  Reference's Name  Title  Phone  
Education
Are you presently a student? Yes No
If not currently attending, when do you plan to attend?
Type of SchoolNameLocation of SchoolDegree/Area of StudyNumber Years AttendedGraduated (Check one)
High School1  2  3  4    Yes  No
College1  2  3  4    Yes  No
Other1  2  3  4    Yes  No
Are you fluent in any other language other than English?    Yes    No Which language?Written  Verbal   Both  
WPM Typing    Word     Excel     Other  
Additional Inquires
Have you ever been dismissed or asked to resign from any employer? Yes No
If yes, please explain:  
Have you been convicted of a crime in the last 7 years? Yes No
If yes, please explain: A conviction will not necessarily disqualify you for employment.  
Permission to Work
Are you legally eligible for employment in the U.S.? Yes No  Proof of U.S. citizenship or immigration status will be required if hired for a position.
Referral Source
Walk in Applicant Employment Agency Newspaper (Name)   Internet (Source)  
School Employee Referral (Name)       Other(Specify)     
Additional Questions
Why are you interested in working for our company?  
What strengths would you bring to our company?  
What didn't you like about your previous jobs?   
If hired, I agree to abide by the rules of the company. If hired, I understand that my employment is at will. This means that I do not have a contract of employment for any particular duration or limiting the grounds for my termination in any way. I am free to resign at any time. Similarly, the company is free to terminate or change the terms and/or conditions of employment at anytime for any reason or no reason at all. The only time my at will status or anything contained herein could be changed is if I were to enter into a written contract with an authorized representative (Human Resources Director, COO, or CEO) of the company explicitly promising me job security. All of the information I have supplied in this application to the best of my knowledge is true and complete statement of the facts, and if employed, any omissions or false or misleading statement(s), on this application or during the interview process could result in immediate dismissal regardless of when such information is discovered. I further authorize all courts, probation departments, prosecutor's office, boards, employers, references, educational and credit companies, consumer agencies, without exception, to furnish the company or its representatives any and all information any of them have concerning me. I further authorize a check by any consumer agency of my employment history as well as any incidents of employment dishonesty, retail theft, credit/bankruptcy, or criminal activity. I understand that my employment and/or retention may be affected in whole or in part from a report or any information either verbally or in writing received from this agency or any of the above mentioned entities, companies, or persons. I hereby discharge and exonerate the company, its agents and representatives, or any person entity so furnishing information or the investigation made by the company. A Photostat copy or fax of this authorization will be considered as effective and valid as the original. (Whenever legally required, a copy of any credit report and other information will be available upon request.)I agree to protect the company's confidential information, trade secrets and other proprietary information and will not reveal such information, which I am informed (verbally or written) is confidential or which anyone could perceive is confidential to anyone at anytime during or after cessation of my employment.I further understand that the company will not employ persons who use illegal drugs or engage in substance abuse, and that the company retains the right to screen from employment such individuals.
By Checking this box, you agree that the information is true and correct.
Attach your resume