| *Date:
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Date Available to Begin:
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| *Full Name:
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| First:
Middle:
Last:
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| *Present Address: |
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| City: |
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| Zip Code: |
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| *Phone Number (Daytime): |
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| *Phone Number (Evening): |
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| E-mail Address: |
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| *Are you 18 years or older?: |
Yes
No |
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| *Have you been convicted of a crime within the last 7 years? |
Yes
No |
If yes, please explain:
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| *Select Preference: |
Convenience Store
Restaurant
Either |
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Starting Pay Desired:
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If restaurant, please list type of position desired:
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| *Specify hours available for each day of the week: |
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| Available for overtime?: |
Yes
No |
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| Have you ever worked for this company before?: |
Yes
No |
| If yes, what?: |
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| High School: |
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| Address: |
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| Years Completed:
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Course Study/Diploma:
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| College: |
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| Address: |
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| Years Completed:
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Course Study/Diploma:
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| Post College: |
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| Address: |
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| Years Completed:
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Course Study/Diploma:
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| Trade/Business/ Correspondence: |
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| Address: |
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| Years Completed:
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Course Study/Diploma:
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Please provide any additional information such as special skills, training, management experience, equipment operation or other qualifications you feel will be helpful in considering you application:
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Why would you like to work for our company?:
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| List the most recent one first |
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| Dates:
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Name, Address, and Phone Number of Employer:
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Positions Held/Responsibilities:
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| Reason for leaving: |
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| Dates:
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Name, Address, and Phone Number of Employer:
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Positions Held/Responsibilities:
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| Reason for leaving: |
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| Dates:
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Name, Address, and Phone Number of Employer:
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Positions Held/Responsibilities:
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| Reason for leaving: |
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| List three individuals not realated to you that you have known for at least one year. |
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| Name: |
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| Address: |
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| Phone Number: |
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| Years Acquainted: |
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| Name: |
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| Address: |
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| Phone Number: |
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| Years Acquainted: |
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| Name: |
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| Address: |
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| Phone Number: |
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| Years Acquainted: |
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Additional comments you feel are important for us to know (if any):
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| It is the intent of Golightly & Long to establish and maintain a drug and alcohol free working environment for the safety, health and well-being of its employees and the people, products and workplace with which they come in contact. To accomplish this, all employees, associates, contracted personnel and affiliated employees must submit to the Drug and Alcohol testing program as set forth in the company policy handbook:
All candidates, prior to becoming an employee of Golightly & Long, will be required to submit to a pre-employment drug screen.
*
I certify that the facts contained on this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application may result in termination on my employment.
*
I understand that by submitting this form I am signing the Consent Form and agree to company background searches.
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