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FlavorJeans Employment Application

Instructions: Type or print clearly in black or blue ink. Answer all questions.
NAME (Last, First, Middle) ________________________________________	SOC. SEC. # ___________________
ADDRESS (Number and Street, City, State, Zip Code) ________________________________________	PHONE NO. (___)______________
POSITION DESIRED ________________________________________	Full-time ___	Part-time ___
	Temporary ___
HAVE YOU WORKED FOR THIS COMPANY BEFORE?	Yes ___	No ___
IF YOU ARE A MINOR UNDER AGE 18, DO YOU HAVE A CERTIFICATE OF AGE OR EMPLOYMENT?	Yes ___	No ___

EDUCATION
	NAME AND ADDRESS OF SCHOOL	MAJOR	DEGREE/ DIPLOMA
High School	_________________________ _________________________  _________________________  _________________________	____________  ____________  ____________	____________ ____________ ____________
College	_________________________ _________________________  _________________________  _________________________	____________  ____________  ____________	____________ ____________ ____________
Trade, business, other	_________________________ _________________________  _________________________  _________________________	____________  ____________  ____________	____________ ____________ ____________

SPECIAL SKILLS AND QUALIFICATIONS: List job-related licenses, skills, training, honors, awards, and special accomplishments _____________________________________________________________ _____________________________________________________________

EMPLOYMENT HISTORY: (START WITH PRESENT OR LAST POSITION)
Employer: _____________________________________________________
Address:______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________
Position Title: ___________________________
From: ______________ To: ______________
Duties: ____________________________________________________ __________________________________________________________
Salary: _______________ _______________
(first) (last)
Reason for leaving: _____________________
Employer: _____________________________________________________
Address:______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________
Position Title: ___________________________
From: ______________ To: ______________
Duties: ____________________________________________________ __________________________________________________________
Salary: _______________ _______________
(first) (last)
Reason for leaving: _____________________
Employer: _____________________________________________________
Address:______________________________________________________
Supervisor: ____________________________________________________
Phone: _______________________________
Position Title: ___________________________
From: ______________ To: ______________
Duties: ____________________________________________________ __________________________________________________________
Salary: _______________ _______________
(first) (last)
Reason for leaving: _____________________

MAY WE CONTACT YOUR PRESENT EMPLOYER? Yes _____  No _____

REFERENCES: (EXCLUDE RELATIVES AND FORMER EMPLOYERS)
	Name/Title	Address and Phone No.	Occupation
1.	_________________________ _________________________	_____________________  _____________________  _____________________	__________________
2.	_________________________ _________________________	_____________________  _____________________  _____________________	__________________
3.	_________________________ _________________________	_____________________  _____________________  _____________________	__________________

I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT ANY FALSE INFORMATION ON THIS APPLICATION MAY BE GROUNDS FOR NOT HIRING ME.

DATE________________SIGNATURE______________________________