Hacketts Online

Employment Application

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APPLICATION FOR EMPLOYMENT FORM

To be considered for employment at Hacketts, this Application for Employment Form must be completed by the applicant. Each question must be answered in full, even if a resume is provided. If an answer is NO or NOT APPLICABLE, indicate such. Please note that you still may be required to fill out a written application prior to any possible employment offers.

Hacketts an Equal Opportunity Employer. We consider all applications for all positions without regard to race, color, religion, gender, national origin, age, sexual orientation, physical or mental disability, marital status, veteran status, or any other legally protected class or status.

Personal Information

If you have one, you may upload a resume here. You are still required to fill out the information in the "Personal Information" section of this form.

Upload resume

Full Name: ( First, Middle, Last ) *

Telephone Number: *

Street Address: *

City: *

State: *

Zip Code *

Your eMail:

Position Applying For and Store Location:
|

Salary or Wage Desired:

Date Available to Start:

Are you Available to Work: * ( Check all that apply )

Full-Time
Day

Part-Time
Evening

Temporary
Nights

Are you 18 years of age or older? *

Yes No

Have you previously submitted an Application for Employment Form and/or been interviewed for employment with us? *

Yes No

If Yes, give Month and Year.

Have you ever been employed with our company before? *

Yes No

If Yes, give Dates.

- to -

Are you legally eligible for employment
in the United States?*
Employment eligibility will be verified upon employment.

Yes No

If you have recieved a copy of the job description for the position for which you are applying, can you perform the essential functions of this job with or without reasonable accomodation?

Yes No
Job Description Not provided

Education

Type of School Attended	Name and Location of Scool	# years	Coarses of Study/Major	Diploma or Degree Obtained	GPA
High School Or Preparatory
College
Other

Skills
Data Entry
Typing Speed: WPM	# Numeric Keystrokes / Hour

Computer Skills:	# Alpha Keystrokes / Hour

List any additional job-related skills, technical, or professional knowledge that you feel would support your qualifications for employment:	List any certificates, licenses, or professional achievements that would support your qualifications for employment:

Employment History

Provide employment information, Including military service, for your last 3 positions, starting with the most recent employer first. If you held more than three jobs, your may provide this information in the ADDITIONAL INFO text box located at the bottom of this form.

If current employer, may we contact to obtain employment information?

Yes No

Name of Employer:

Telephone Number:

Address:

City

State:

Zip Code:

Employment Dates ( Month / Year )
From to

Starting Pay Rate

Current/Final Pay Rate

Job Title of Position

Name and Job Title of Supervisor

Brief description of job duties, responsibilities and significant accomplishments.

Reason for leaving:

Name of Employer:

Telephone Number:

Address:

City

State:

Zip Code:

Employment Dates ( Month / Year )
From to

Starting Pay Rate

Current/Final Pay Rate

Job Title of Position

Name and Job Title of Supervisor

Brief description of job duties, responsibilities and significant accomplishments.

Reason for leaving:

Name of Employer:

Telephone Number:

Address:

City

State:

Zip Code:

Employment Dates ( Month / Year )
From to

Starting Pay Rate

Current/Final Pay Rate

Job Title of Position

Name and Job Title of Supervisor

Brief description of job duties, responsibilities and significant accomplishments.

Reason for leaving:

Additional job info:

TERMS AND CONDITIONS

I hereby certify that all of the information I have provided on this Application for Employment Form is accurate and complete to the best of my knowledge. I understand that any misrepresentation or omission of facts will disqualify me from further consideration of employment, withdrawal of any offer of employment, or termination of employment, if hired.

I authorize verification of all of the information I have provided on this Application for Employment Form as well as any additional information needed to consider my application for employment. I authorize all previous employers, educational institutions, references, and other persons who have knowledge of me or my records to provide any and all information pertinent to my employment and release the same from any liability resulting from providing such information. I also release this organization and all of its employees from all liability for any damage that may result from reliance on the information furnished.

The company is committed to providing a drug and alcohol-free workplace. After receiving a conditional offer of employment, I understand that a random drug test could occur at anytime during my employment. If the results of the test are positive, I understand that the offer of employment will be withdrawn.

If employed, I agree to abide by all policies, procedures, rules, and regulations of the organization. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated by myself or the company at any time with or without cause or notice. I further understand that the policies, procedures, rules, and benefits contained in the employee handbook, benefit plans, and other written documents should not be considered an employment contract for any period of time.

I have read and agree to the terms stated above*

YES, I AGREE