Almost Anything, Big Rs Got It!
CSWW INC., DBA BIG R STORES APPLICATION FOR EMPLOYMENT
INCOMPLETE OR UNSIGNED APPLICATIONS WILL NOT BE CONSIDERED Please Print in Ink
Position(s) Applied For Date of Application 8/12/11 First Name Middle Name
Any
Last Name
Callaway
Address Number
Amanda
Street City
Marie
State Zip Code
805 Allen St Apt A
Telephone Number(s) and email address
South Pekin
IL
Social Security Number
61564
309-620-5980 309-613-4515 Naughty4u@[Link]
327-74-5221
How Did You Learn of This Opening?
Advertisement Friend in_________________ Inquiry Employment Agency Other_Walk-
If hired, can you show proof of authorization to work in the United States?
(Proof of citizenship or immigration status will be required upon employment).
Yes
No
Availability:
Full Time
Part Time
% Part Time
Temporary/Seasonal
Date Available
Have you ever worked for Big R Before? Yes
No If yes, please give dates:_________________________
Have you ever been convicted of a felony? (Conviction will not necessarily disqualify you from employment) Yes No If yes, please explain_________________________________________________________________________________ __________________________________________________________________________________________________ Are you able to meet the attendance requirements, and work overtime if and when required? Yes No Yes No
Are you able to provide a valid drivers license if required to drive a vehicle for the companys business?
If No to the above two questions, please explain:_________________________________________________________
PRIOR WORK HISTORY begins on next page. List ALL jobs in order, starting with last or current employer first. Go back at least 10 years, more if relevant. Account for any gaps in employment and list specific reasons for leaving. Explain your exact primary duties. Use additional sheets as needed. IMPORTANT: In order to be considered for this job you must list supervisors who will talk with us about performance, attendance, etc. and/or other work references who know and are willing to share this information. The completeness of this information may affect your opportunity.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER
1. Employer Name
Employer Address
Telephone #
Dates Employed Supervisors name/title/phone#
Rate of Pay
Reason for Leaving
Other work reference name/title/phone#
Describe in detail the work you performed. Be specific about your tasks the equipment you used (Explain any gaps in employment here.)
2. Employer Name
Employer Address
Telephone #
Dates Employed Supervisors name/title/phone#
Rate of Pay
Reason for Leaving
Other work reference name/title/phone #
Describe in detail the work you performed. Be specific about your tasks the equipment you used (Explain any gaps in employment here.)
3. Employer Name
Employer Address
Telephone #
Dates Employed Supervisors name/title/phone #
Rate of Pay
Reason for Leaving
Other work reference name/title/phone #
Describe in detail the work you performed. Be specific about your tasks the equipment you used (Explain any gaps in employment here.)
4. Employer Name
Employer Address
Telephone #
Dates Employed Supervisors name/title/phone #
Rate of Pay
Reason for Leaving
Other work reference name/title/phone #
Describe in detail the work you performed. Be specific about your tasks the equipment you used (Explain any gaps in employment here.)
5. Employer Name
Employer Address
Telephone #
Dates Employed Supervisors name/title/phone #
Rate of Pay
Reason for Leaving
Other work reference name/title/phone #
Describe in detail the work you performed. Be specific about your tasks the equipment you used (Explain any gaps in employment here.)
EDUCATION School High School Undergraduate College Graduate Professional Other (Specify)
Name and Address of School Pekin Communtity Pekin,IL
Course of Study General 4
Years Completed
Diploma/Degree
yes
Midstate College Peoria,IL
Computer Science
no
SPECIALIZED SKILLS Describe any other job related specialized training or skills or other experience that you believe may help you qualify for the position for which you are applying. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Can you perform the essential job functions of the position for which you are applying?
PROFESSIONAL REFERENCES: (Use current references other than supervisor) Name:____Terri Thomlinson_______________________________Phone/Email:3096427859_____________________________
Yes No
Name:__Shyela Edwards_______________________________________________ Phone/Email:309-6134515_______________________________ Name:__Sandra Jackson_______________________________________________ Phone/Email:__309-2411983______________________________
APPLICANTS STATEMENT I certify that the information provided herein and attached to this Application for Employment is true and complete. I authorize the company and its agents to investigate or confirm all statements contained in this Application for Employment as may be necessary in arriving at an employment decision, including the use of any relevant public information available. Additionally, I authorize any individual or former employer to provide job related information as may be necessary to determine my suitability for employment. All inquiries will be in accordance with the provisions of the Fair Credit Reporting Act. In the event of employment, I understand that false, misleading information or material omissions given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all company policies and procedures and that they may from time to time be changed, suspended, revoked, terminated or superseded by company management.
_______Amanda Callaway___________________________________8/12/11___________ ___________________________ Signature of Applicant Date