General Information

Have you ever applied to our company before? If yes, where?
If you have ever worked for our company before, state where, when, final position and reason for leaving:
Store Location Desired
Lenexa, KS Grandview, MO
Shifts Desired
Mornings 

Afternoons 

Evenings 

Overnights 
Full Time 
(32 Hours or More)
Part Time 
(Less than 32 Hours)
Seasonal 
(3 Months or Less)
Age: Are you at least 18 Years of Age? Yes  No 
         Are you at least 16 Years of Age? Yes  No 
DO YOU HAVE ANY RELATIVE NOW EMPLOYED BY OUR COMPANY? YES  NO 
IF YES, IDENTIFY BY NAME(S), POSITION AND LOCATION:

 

Work Experience

List your previous experience beginning with your most recent position:

Recent Job 1

Dates of Employment
Start:

End:

Recent Job 2

Dates of Employment
Start:

End:

Recent Job 3

Dates of Employment
Start:

End:
 

Personal References

   

Education and Training

School Please Print Name, Street, City, State & ZIP Code For Each School Number of Years Completed Degree? Type of Course/ Major
High School
College
Additional Training
 
If job related, indicate the job skills which you have performed:
Cash Register Computers Stock/Inventory
Typing ( WPM) Other 
  

Additional Employment History Inquiries

Have you ever been dismissed or forced to resign from any employment?
Yes  No  If yes, please explain: 
Have you ever been convicted of a felony crime or theft-related misdemeanor? (Omit information regarding marijuana convictions if over 2 years old.)
Yes  No  If yes, please explain: 
 

Permission To Work

If employment is offered, can you submit verification of your legal right to work in the United States?
Yes No
 

Referral Source

Career Objectives

How did you hear of this position? Why are you interested in working for our company, and what are your career objectives?
Walk-In Applicant  
Online Source Name: 
Employment Agency Name: 
School/College Name:  What are some things you didn't like about jobs you have had?
Other Name: 
Employee Referral Name: 
Newspaper Ad Name: 
 

Applicant's Statement

Have you ever been convicted of a felony? No Yes
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentece(s) imposed, and type(s) of rehabilitation.
Signature  Date