Tallassee - Wetumpka - Millbrook - Prattville - clanton - Selma

Employment Application All fields MUST be completed for considerationPLEASE NOTE: to select a check box, double left click on box desired, select your “default value” then press ok to the close window.

Applicant Information

Last Name / First / M.I. / Date
Street Address / Apartment/Unit #
City / State / ZIP
Phone / E-mail Address
Date Available / Desired store location? / Desired Salary
Date of Birth: / Full / Part time?
Position Appling for: / Customer Service Rep or PC Technician >
Are you a citizen of the United States? / YES / NO / If no, are you authorized to work in the U.S.? / YES / NO
Have you ever worked for this company? / YES / NO / If so, when?
Have you ever been convicted of a felony? / YES / NO / If yes, explain
Will you agree to, and pass a drug test? / YES / NO / If no, explain
Valid Driver License? / YES / NO / If no, explain
Do you currently OWN a vehicle? / YES / NO / If no, explain
Are you willing to attend an unpaid 8 hour orientation to help our decision? / YES / NO / If no, explain
Can you type? / YES / NO / If yes, WPM=
Are you willing to provide a copy of your background police report / YES / NO / If no, explain
List below any computer experience you may have:
List any software programs you are familiar with:

Education

High School / Address
From / To / Did you graduate? / YES / NO / Degree
College / Address
From / To / Did you graduate? / YES / NO / Degree
Other / Address
From / To / Did you graduate? / YES / NO / Degree

References

Please list three professional references.
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address
Full Name / Relationship
Company / Phone / ( )
Address

Previous Employment

Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO

cOMMENTS: #1

Please state below in your own words why you should be chosen for this positions

cOMMENTS: #2

Any other comments you may have, please state below…….

Video chat interview

If you would like to request an interview through video chat, please provide the below information
Circle your video chat client: Skype Yahoo Google-Talk Username? ______
We will contact you via email or SMS text message regarding the time of your scheduled video chat interview.

Military Service

Branch / From / To
Rank at Discharge / Type of Discharge
If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Electronic Signature: type your name here> / Date

Email Employment Application to:

*Photo submissions are optional, if you so desire can be email with application as an attachment