Last In Concepts

Employment Application

Location Applying For
Position Applying For

Name (First, Last)

Nickname(s)

Address	City, State and ZIP
Phone Number	Mobile/Pager/Other:	E-mail
Date Available to Start:	Salary Requirement:

If you are under 18 and we require a work permit, can you furnish one? Yes No If no, please explain:	Have you ever worked for this company? Yes No If yes, when?	Are you a citizen of the United States? Yes No If not, are you legally allowed to work in the United States? Yes No
Type of employment desired:	Full-Time Part-Time Temporary Seasonal
Have you ever pleaded "guilty," "no contest," or been convicted of a crime? Yes No	If yes, give dates and details:	Answering "yes" to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
Driver's license number if applicable to position:	State
Summarize Your Special Skills or Qualifications

Previous Employment 1 (most recent position)

Dates of Employment From To		Position(s) Held
Firm	Address	Phone
Supervisor	Title	Responsibilities
Starting Salary and Title	Ending Salary and Title	Reason for leaving
May we contact this employer for a reference?		Yes No

Previous Employment 2

Dates of Employment From To		Position(s) Held
Firm	Address	Phone
Supervisor	Title	Responsibilities
Starting Salary and Title	Ending Salary and Title	Reason for leaving
May we contact this employer for a reference?		Yes No

Previous Employment 3

Dates of Employment From To		Position(s) Held
Firm	Address	Phone
Supervisor	Title	Responsibilities
Starting Salary and Title	Ending Salary and Title	Reason for leaving
May we contact this employer for a reference?		Yes No

Experience

Please detail any retail/service industry experience:

What sets you apart in your most recent job?

Education

High School (name, location)	Have you attended college? Yes No (if no, skip to "Personality & Background")	If yes, please list college(s) and dates of enrollment:
Did you graduate from college? Yes No	Degree(s)	GPA
	Awards/honors	Additional comments

Personality & Background

Hometown	How many Facebook friends to do you have?
What is your favorite movie & why (excluding The Hangover)?	List the top three restaurants and bars you visit and why:
What makes you unique(excluding "personality", "sense of humor", "smile", "eyes", "laugh", etc)	List any athletic or team oriented background. How are you competitive?
What are your long term goals and dreams?	Why should we hire you?
Why do you want to work for us?	How did you hear about us?
If you could refer 3 people or friends to us for hire, who would they be and why?

Sign & Confirm

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in
discharge.

Signature of Applicant:

Date

Please enter the security code pictured to above