First Name: *
Last Name: *
Email: *
Address: *
City: *
State: *
Zip Code: *
Primary Phone:
Secondary Phone:
How did you hear about Shoemaker:
—Newspaper AdEmployee ReferralFormer Shoemaker EmployeeOther, Walk-inWord of Mouth/PressDirect CompetitionCurrent Shoemaker EmployeeExternal ReferralOnline Job Search
Are you over 18 years of age? Yes No
Are you legally eligible for permanent employment in the United States? Yes No
Position Applied for:
Full Time or Part Time: Full time Part time
Date available for work:
Have you worked for us before? Yes No
Salary or Wages Desired: $
—$5 - $7 per hour$8 - $9 per hour$10 - $11 per hour$12 - $13 per hour$14 - $15 per hour$16 - $17 per hour$18 - $19 per hourAbove $20 per hour
Special Qualifications and skills:
Education:
—Please SelectNot a Hight School GraduateGED / High School DiplomaTechnical or Trade SchoolAssociate’s DegreeBachelor’s DegreePost Graduate Degree
Years of related experience:
—Please SelectLess than 1 year1 - 3 years4 - 5 years6 - 7 years8 - 9 years9 - 10 years10 or more years
Employment History - Provide the following information of your past and current employers or volunteer activities, starting with your most recent. Please provide information for the past 5 years or as space permits including any applicable military experience. Explain any gaps in employment in the comments section below.
#1
Employer Name:
Location:
Phone:
Job Title:
Responsibilities:
Supervisor Name:
Starting Salary:
Ending Salary:
Start Date:
End Date:
Reason for leaving:
#2
#3
Name:
Address:
Years Known:
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
In consideration of any employment, I agree to conform to the rules and regulations of the company and my employment and compensation can be terminated, with or without cause, and no other employee has any authority to enter into any agreement for employment for any specified period of time or make any agreement contrary to the foregoing.
Employment is subject to passing a drug test.
By typing my name in the signature box below and submitting this information, I acknowledge that I have read, agree and will comply with the information above.
Date Signature*
