Application for Weekend Office Assistant

 

Basic Information

 

First Name*

 

Last Name*

 

Middle Name*

 
 
 

Present Address*

 

City*

 

State*

 

Zipcode*

 
 
 

Phone Number*

 

Permanent Phone Number*

 

Email Address*

 

19 years or older?*

 
 
 
 
 

Education

 

Are you currently a student?*

 

Where?

 

Major/Area of Study?

 

Expected Graduation Date?

 
 
 

Are you a college graduate?*

 

Where?

 

Are you a high school graduate?*

 

Where?

 
 
 
 
 

Driving Information

 

Do you have a valid driver's license?*

 

Driver’s License (State)

 

License Number

 

Expiration Date

 
 
 

Have you been convicted of a DUI within the last five years?*

 
 
 
 
 

Background Information

 

Have you been convicted of a felony within the last 7 years?*

 
 
 

If yes, explain below (conviction will not necessarily disqualify applicant from employment)

 
 
 
 
 

Special Skills

 

Do you have any special skills which you would like to tell us about?

 
 
 
 
 

Physical Limitations

 

Are you able to lift 20lbs numerous time throughout the day?

 
 

Are you able to remain standing for extended periods of time?

 
 

Are you able to remain sitting for extended periods of time?

 
 

Are you able to bend or squat repeatedly over an extended period of time?

 
 

Are you able to perform task with your hands/fingers throughout the day (hold, grasp, pick, pinch)?

 
 

If no to any question, what can be done to accommodate your limitation?

 
 
 
 
 

Employment History

 

Name & Location of Employer

 

Address

 

From

 

To

 
 
 

Supervisor

 

Your positions / responsibilities

 
 
 

Reason for Leaving

 
 
 
Add another
 
 
 
 

Personal References

 

Name

 

Relation

 

Phone Number

 
 
 
Add another
 
 
 
 

Other Questions

 

How did you learn about this opening?

 
 

How does a temporary seasonal position fit into your plans?

 
 

What about this position appeals to you?

 
 

Are you able to work Sat 8am to 4pm and Sun 10am to 6pm?

 
 

If no to the above, what change to the schedule would you need?

 
 
 
 
 

Release and Confirmation

 

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal.

I authorize investigation of all statements contained herein and the referrals listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, any employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.

I understand that entering my full legal name in the box below is the electronic equivalent of a signature.

 
 
 

Enter your full legal name in the box below if you agree to the Release and Confirmation.*

 
 
 
 
 

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