Ameripawn Employment Application

Preliminary Information

Position Your Applying For

Referal Source

Name of Source (if applicable)

Personal Information

Name


Last Name

First Name

Middle Name

Address


Street

City

State

Zip

Telephone

Cellphone

Email Address

Social Security Number

General Information

May we contact you at work?

If yes, phone number and best time to call

If you are under 18, can you furnish a work permit?

Have you filed an application here before?

If yes, give date

Have you ever been employed here?

If yes, give dates

to

Will you undergo a pre-employment physical if required?

Will you submit to a pre-employment and/or random drug and alcohol test?

Are you legally eligible for employment in this country?

Date available for work

Type of employment desired:

Are you on a layoff and subject to a recall?

We have stores in several different cities. Will you travel if the job requires it?

Will you work overtime if required?

Have you ever been bonded?

Have you been convicted of a felony in the last 7 years?

If yes, please explain

Current and valid driver's license may be required.


Driver's licence number

State

Employment History

List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in comments section below.

Employer 1

Employer Name

Telephone

Address


Street

City

State

Zip

Job Title

Immediate Supervisor and Title

Reason for Leaving

May We Contact for Reference

Dates Employed

to

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Summarize the nature of the work performed and job responsibilities:

Employer 2

Employer Name

Telephone

Address


Street

City

State

Zip

Job Title

Immediate Supervisor and Title

Reason for Leaving

May We Contact for Reference

Dates Employed

to

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Summarize the nature of the work performed and job responsibilities:

Employer 3

Employer Name

Telephone

Address


Street

City

State

Zip

Job Title

Immediate Supervisor and Title

Reason for Leaving

May We Contact for Reference

Dates Employed

to

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Summarize the nature of the work performed and job responsibilities:

Employer 4

Employer Name

Telephone

Address


Street

City

State

Zip

Job Title

Immediate Supervisor and Title

Reason for Leaving

May We Contact for Reference

Dates Employed

to

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Summarize the nature of the work performed and job responsibilities:

Comments about your employment history(including explanation of any gaps in employment):

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our company:

Educational Background

A. List last three (3) schools attended, starting with the last one. B. List number of years completed. C. Indicate degree or diploma earned, if any. D. Grade Point Average or Class Rank and E. major and minor field of study (if applicable).

School 1

School Name


Years Completed

Degree

GPA

Major

Minor

School 2

School Name


Years Completed

Degree

GPA

Major

Minor

School 3

School Name


Years Completed

Degree

GPA

Major

Minor

List any foreign language(s) and check the box that best describes your skill level

Foreign Language 1



Foreign Language 2



Foreign Language 3



References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Reference 1

Name

Telephone

Years Known

Reference 2

Name

Telephone

Years Known

Reference 3

Name

Telephone

Years Known

List professional, trade, business or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national orgin, age, ancestry or other protected status.)

Organization 1

Name

Offices Held

Organization 2

Name

Offices Held

Organization 3

Name

Offices Held

List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status.)

List any additional information you would like us to consider.

Miscellaneous Questions

Vietnam Era Veteran

If you are handicapped and wish to be identified as such according to the Rehabilitation Act of 1973, please indicate by checking the box

Terms and Conditions

It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, AmeriPawn reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of AmeriPawn has the authority to make any assurances to the contrary.

I give AmeriPawn the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability AmeriPawn and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information.

AmeriPawn is an equal opportunity employer. AmeriPawn does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state, or federal law.

This application is current for 60 days only. At the conclusion of this time, if I have not heard from AmeriPawn and still wish to be considered for employment, it will be necessary for me to fill out a new application.

Do you agree to the above terms and conditions?

Give a brief explanation of the reason you think AmeriPawn, Inc. would be a good place for you to work.