Lorena L., Fairview

Location

Nashville
Hendersonville
Franklin

Candidate's Information

First Name:*

Last Name:*

Date:*

Address:*

Phone:*

Email:*

Are you 18 years old or older?*

Yes
No

Are you either a U.S. citizen or an alien authorized to work in the U.S.?*

Yes
No

Have you ever worked or attended school under another name? If so, under what name?

Do you have reliable transportation?*

Yes
No

Have you ever been fired from a job?*

Yes
No

Do you have experience with POS systems?*

Yes
No

Position:*

Start Date Available:*

Do you prefer:*

Full-time
Part-time

Hours per week desired:*

Hours you are available to work:*

Days of week you are available to work:*

Are you able to work:

Weekends*

Yes
No

Holidays*

Yes
No

Nights*

Yes
No

Are you available to work overtime?*

Yes
No

Education

Highschool:*

Graduated

Yes
No

College/University/Tech School:*

Graduated

Yes
No

Course of Study:

Other education, training or special skills:

Work Experience

Please list all previous employment, beginning with the most recent.

Employer:

Address:

From

To

Position Held:*

Reason for leaving:

Supervisor’s Name & Title:

May we contact?

Yes
No

Description of Duties:

Starting Hourly Pay:

Final Hourly Pay:

Employer 2:

Address:

From

To

Position Held:*

Reason for leaving:

Supervisor’s Name & Title:

May we contact?

Yes
No

Description of Duties:

Starting Hourly Pay:

Final Hourly Pay:

Authorization and Acknowledgements

Consent*

I certify that I have not knowingly withheld any information that might affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure this employment can be grounds for rejection of my application or, if I am employed by this company, can be grounds for my immediate termination from the company.

I permit the company to check and verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation.

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any and all information listed above.

By checking this box, I acknowledge and accept all the above terms and conditions.*

Candidate’s Signature*

Date*