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APPLICATION FOR EMPLOYMENT

Please remember to sign and date your application form before returning it to Human Resources.

First Name

Last Name

M.I

Address

City

State and ZIP code

Home phone

Work phone

How were you referred to elegant xpressions BTQ?

Employed here before?

Yes No

Where and when?

Position(s) applied for

Hours you are available to work

Name and location of High school

Did you graduate?

Yes No

If no, or still attending, highest grade completed

Receive G.E.D.?

Yes No

Name & location of college, technical, graduate school

Major

Degree

Date conferred

Computer skills & abilities (systems, software. etc.)

Other courses, training, education

U. S. Military: branch

From

To

Traning or specialty

Clerical applicants only 1

Clerical applicants only 2

Clerical applicants only 3

If you are applying for a position that requires a driver's license, do you possess a legal and current driver's license?

Yes No

If yes, indicate class

Professional licenses, certifications, registrations

Type

Issued by

Number

Date

Expires

Have your professional licenses, certificates, or registrations ever been suspended, revoked, or placed on probation?

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If yes, explain fully

List past employers with the present or most recent listed first

Yes No

Date employed

Employer and address

Date employed 1

May we contact?

Yes No

Supervisor

Telephone number

Your occupation

Describtion of duties

Reason for leaving

Have you ever been discharged from employment?

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If yes, explain fully below

Have you ever been convicted of a felony?

Yes No

Date ___

Offense

List three individuals not related to you who can evaluate your work performance

Name 1

Name 2

Name 3

Address Reference 1

Address Reference 2

Address Reference 3

Telephone Reference 1

Telephone Reference 2

Telephone Reference 3

Occupation 1

Occupation 2

Occupation 3

Agreement

SIGNATURE

DATE

Is any additional information relative to your name necessary to enable a check of your employment record?

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If yes, list other names used

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5005 S. Western Ave
Sioux Falls, SD 57108

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January - April 1

Mon-Fri: 12-6
Sat: 10-4
Sun: 12-4

April 1 - December

Mon-Fri: 12-4
Sat: 10-4
Sun: Closed

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