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Employment Application
Personal Data (All Personal Data is Required)
First Name:
Middle Name:
Last Name:
Street Address:
City:
State:
Zip:
Telephone (###-###-####):
Are you at least 16?
Yes
Are you at least 18?:
Yes
Have you ever been convicted of a felony? (Answering "Yes" does not automatically disqualify you from employment)
No
Yes
Education (High School Name is Required)
High School:
Address:
Grade Completed:
Did you Graduate?:
Yes
No
Other Schooling:
Address:
Years Completed:
Did you Graduate?:
Yes
No
Degree:
References
List any two personal references, at least 18 years of age, we may contact (Do not include relatives, former employers, or employees of SKH):
Reference 1:
Name:
Address:
Occupation:
Years Known:
Telephone (###-###-####):
Reference 2:
Name:
Address:
Occupation:
Years Known:
Telephone (###-###-####):
Location Desired
Dover
East York
Garden Distribution
Harrisburg
Hummelstown
Lebanon
Lititz Pike
Mechanicsburg
Oregon Pike
Rohrerstown
Central Office
Garden Center Office
Supermarket Distribution
Type of Work Desired
First Choice:
Second Choice:
Desired Wage:
Are you seeking:
Full Time
Part Time
Seasonal
How did you hear about employment with Staffers of Kissel Hill?
Availability
Date available to start (M/D/YYYY):
Are you presently employed?:
No
Yes
If yes, may we contact your employer?:
Yes
No
Specify All Days and Hours Available
Day
AM
PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Specify All Shifts Available For Work
Early Morning
Day Hours
Evening Hours (4pm-close)
Overnight Hours
Other
If Other, please specify:
Employment History
Applications for employment with Stauffers of Kissel Hill must reflect a complete work history. If enough space is not provided here, please fully utilize the spaces available, and the remaining work history may be given at a later date. Applications deemed to be incomplete in any way will not be considered for employment.
Most Recent employer:
Name:
Address:
Position:
Telephone (###-###-####):
Start Date (M/D/YYYY):
End Date (M/D/YYYY):
Name of Supervisor:
Reason for Leaving:
Previous employer:
Name:
Address:
Position:
Telephone (###-###-####):
Start Date (M/D/YYYY):
End Date (M/D/YYYY):
Name of Supervisor:
Reason for Leaving:
Previous employer:
Name:
Address:
Position:
Telephone (###-###-####):
Start Date (M/D/YYYY):
End Date (M/D/YYYY):
Name of Supervisor:
Reason for Leaving:
Previous employer:
Name:
Address:
Position:
Telephone (###-###-####):
Start Date (M/D/YYYY):
End Date (M/D/YYYY):
Name of Supervisor:
Reason for Leaving:
Previous employer:
Name:
Address:
Position:
Telephone (###-###-####):
Start Date (M/D/YYYY):
End Date (M/D/YYYY):
Name of Supervisor:
Reason for Leaving:
Acknowledgement
I certify that any misrepresentation or omission of any fact on the application, resume, or any other materials, or any interview can be justification for refusal of employment or termination of such employment. I understand that as a condition of employment, I may be required to submit to drug testing and/or successfully complete an employment physical.
In processing my application for employment, the company may verify all the information I have provided or may have prepared an investigation consumer report concerning my prior employment, education, general character reputation, personal characteristics, and mode of such a report was requested and with full information as to the nature and scope of the investigation.
The Employment agreement Stauffers of Kissel Hill maintains with its employees is an "At Will" agreement.
I understand and agree that my employment may be terminated at any time for any reason, with or without advance notice. I also understand that no manager or representative of the company other than the CFO has the authority to enter into an agreement or make any representations contrary to the Employment At Will agreement. I understand that no such agreement entered into by the CFO shall be enforceable unless it is in writing and signed by the CFO.
By checking ACKNOWLEDGE below, you accept and agree to all of the above terms.
Acknowledge