15 Derry St Hudson NH 03051
Phone 603-882-5400 Fax 603-484-8261: [email protected]
APPLICATION for EMPLOYMENT
Position: ________________________________ Salary Desired: $ _______________ per hr / mo / yr
Personal Data:
Name _____________________________________________ e-mail _______________
Address____________________________________________ City ______________________ Zip
Home Phone #
Cell Phone #
Other Tel #
New Hampshire Resident
Yes
No Since
Work status
Yes
No
Education :
High School
City
State
College / University
City
State
Others
City _____________
State
,
highest grade 9 10
11 12
, Graduated year
GPA
,
highest grade 1 2
, Graduated year
,
from
/
/
_____ _____
, Degree
(circle one)
3 4 5 6
Major
_____
Major
To /
+
(circle one)
/
_____ _____ _____
Experiences ( employment history ) :
Company
City
Phone
Supervisor
Company
City
Phone
Supervisor
Company
City
Phone
Supervisor ________
Position
State
From
_____
Reason(s) for Leaving
May we call?
Yes
Position
State
From
_____
Reason(s) for Leaving
May we call?
Yes
Position
State
From
_____
Reason(s) for Leaving
May we call?
Yes
Salary $
/ _____ / _____ To _____/
per hr / mo / yr
_____ / _____
No, why?
Salary $
/ _____ / _____ To _____/
per hr / mo / yr
_____ / _____
No, why?
Salary $
/ _____ / _____ To _____/
Equal Employment Opportunities ----
per hr / mo / yr
_____ / _____
No, why? _____
page 2
Special Trainings / Skills :
References:
Name ____________________ Relationship _____________________ Tel :
Name ____________________ Relationship _____________________ Tel :
Name ____________________ Relationship _____________________ Tel :
Additional Information :
Where did you learn about our company?
_____ Newspaper Ad ______________________ Referred by friends
Our Web
Walk in
_____ Others : ______________________________________________________
Any relatives / friends are working in Showtime Computers? _____ Yes ________No
If yes, name ___________________________ , relationship ______________________
Which days & hours are you available to work?
Monday _____________________Thursday ___________________ Sunday___________
Tuesday ____________________Friday _______________
Wednesday __________________ Saturday ___________________ Total ________ hrs. / wk
At which location? ___________________ . Are you willing to be relocated? _____Yes _____No
Date available to start work? _____________________________
Have you ever been convicted of a crime? ____ Yes ___ No
If Yes, explain _____________________
_______________________________ . (You will not be denied employment based solely on this answer)
Emergency Contact Name _____________________ Relationship _______________ Tel :
Acknowledgement
I certify that the information contained in this application is true and correct to the best of my knowledge and I
understand that if hired, any misrepresentation, falsification, or material omission of information on this
application shall be grounds for dismissal from employment.
I agree, if I am accepted as an employee, to obey all rules and company regulations and policies of our Store
Showtime Computers, Inc.
I understand and agree that if hired, my employment will start on a probation period of 3 months, in which
regardless of any reason, may be terminated at any time without prior notice.
Applicant’s Signature __________________________________________________ Date
Rev. 03 / 2011