Employment Application
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Contact Information Fax to: (818) 505-0848 Attention: Store Manager Mail to: 11990 Ventura Blvd Studio City, CA 91604 Questions? (818) 505-8384
APPLICATION FOR EMPLOYMENT An Affirmative Action/Equal Opportunity Employer
PERSONAL INFORMATION Name (Last, First, Middle Initial)
Social Security Number
Date of Birth
Present Address (Street, City, State, Zip Code) Permanent Address (if different) (Street, City, State, Zip Code) Home Phone Number (
Work
)
(
Cell Number
May we contact you at work? Yes No
)
Best time to reach you:
POSITION DESIRED You must fill out all sections of this application completely and honestly. This information will be used to determine your eligibility for this position. All application materials become the property of Squeeze, Inc. and will not be returned. Employment Desired (check one): Salary Desired Team Member, Team Lead, Open/unspecified Other:_____________________________________ Specify availability for each day of the week: (Keep in mind store hours Start are 6:30 am – 9:30 pm) End Are you presently employed?
No
Able to work overtime?
Date You can Start
Mon
Tue
Wed
Thur
6:30am 9:30pm
6:30am 9:30pm
6:30am 9:30pm
6:30am 9:30pm
Fri
6:30am 9:30pm
Sat
Sun
6:30am 9:30pm
6:30am 9:30pm
Holidays
6:30am 9:30pm
Yes, why are you looking to change positions?
EDUCATION & SKILLS Name & City of School
# of yrs Completed Graduated Subjects Studied
High School College or Trade School University
Other Interests & Skills
EMPLOYMENT HISTORY List all employment, starting with the last one first (include military and volunteer service). 1st) Employer Name
Dates Employed (month/year) From:____________ To: ____________
Position Title
Paid:
Hourly
Monthly Salary
Full Time Part Time, hrs/wk____________
Start: $____________ Final: $____________ Supervisors Name/Title/Phone
Reason for leaving
Duties:
2nd) Employer Name
Dates Employed (month/year) From:____________ To: ____________
Position Title
Paid:
Hourly
Monthly Salary
Full Time Part Time, hrs/wk____________
Start: $____________ Final: $____________ Supervisors Name/Title/Phone
Reason for leaving
Duties:
Page 1 of 2
3rd) Employer Name
Dates Employed (month/year) From:____________ To: ____________
Position Title
Paid:
Hourly
Monthly Salary
Full Time Part Time, hrs/wk____________
Start: $____________ Final: $____________ Supervisors Name/Title/Phone
Reason for leaving
Duties:
4th) Employer Name
Dates Employed (month/year) From:____________ To: ____________
Position Title
Paid:
Hourly
Monthly Salary
Full Time Part Time, hrs/wk____________
Start: $____________ Final: $____________ Supervisors Name/Title/Phone
Reason for leaving
Duties:
REFERENCES Provide the names of 3 references that you have known for at least one year. Name
Phone Number
Have you ever been arrested or charged with a felony or misdemeanor? No Yes, please explain
Years Known
Relationship/Business
Have you been employed under other names?
No
Yes, list name(s):
Are you authorized to work in the U.S.? Yes No If offered employment, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.
PLEASE READ CAREFULLY AND SIGN
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I understand that nothing contained in this application, or conveyed during any interview which may be granted is intended to create an employment contract. I understand that filling out this form does not indicate there is a position open and does not obligate Squeeze to hire me. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
APPLICANT'S SIGNATURE____________________________________________DATE_________________________
Page 2 of 2
APPLICATION FOR EMPLOYMENT An Affirmative Action/Equal Opportunity Employer
PERSONAL INFORMATION Name (Last, First, Middle Initial)
Social Security Number
Date of Birth
Present Address (Street, City, State, Zip Code) Permanent Address (if different) (Street, City, State, Zip Code) Home Phone Number (
Work
)
(
Cell Number
May we contact you at work? Yes No
)
Best time to reach you:
POSITION DESIRED You must fill out all sections of this application completely and honestly. This information will be used to determine your eligibility for this position. All application materials become the property of Squeeze, Inc. and will not be returned. Employment Desired (check one): Salary Desired Team Member, Team Lead, Open/unspecified Other:_____________________________________ Specify availability for each day of the week: (Keep in mind store hours Start are 6:30 am – 9:30 pm) End Are you presently employed?
No
Able to work overtime?
Date You can Start
Mon
Tue
Wed
Thur
6:30am 9:30pm
6:30am 9:30pm
6:30am 9:30pm
6:30am 9:30pm
Fri
6:30am 9:30pm
Sat
Sun
6:30am 9:30pm
6:30am 9:30pm
Holidays
6:30am 9:30pm
Yes, why are you looking to change positions?
EDUCATION & SKILLS Name & City of School
# of yrs Completed Graduated Subjects Studied
High School College or Trade School University
Other Interests & Skills
EMPLOYMENT HISTORY List all employment, starting with the last one first (include military and volunteer service). 1st) Employer Name
Dates Employed (month/year) From:____________ To: ____________
Position Title
Paid:
Hourly
Monthly Salary
Full Time Part Time, hrs/wk____________
Start: $____________ Final: $____________ Supervisors Name/Title/Phone
Reason for leaving
Duties:
2nd) Employer Name
Dates Employed (month/year) From:____________ To: ____________
Position Title
Paid:
Hourly
Monthly Salary
Full Time Part Time, hrs/wk____________
Start: $____________ Final: $____________ Supervisors Name/Title/Phone
Reason for leaving
Duties:
Page 1 of 2
3rd) Employer Name
Dates Employed (month/year) From:____________ To: ____________
Position Title
Paid:
Hourly
Monthly Salary
Full Time Part Time, hrs/wk____________
Start: $____________ Final: $____________ Supervisors Name/Title/Phone
Reason for leaving
Duties:
4th) Employer Name
Dates Employed (month/year) From:____________ To: ____________
Position Title
Paid:
Hourly
Monthly Salary
Full Time Part Time, hrs/wk____________
Start: $____________ Final: $____________ Supervisors Name/Title/Phone
Reason for leaving
Duties:
REFERENCES Provide the names of 3 references that you have known for at least one year. Name
Phone Number
Have you ever been arrested or charged with a felony or misdemeanor? No Yes, please explain
Years Known
Relationship/Business
Have you been employed under other names?
No
Yes, list name(s):
Are you authorized to work in the U.S.? Yes No If offered employment, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.
PLEASE READ CAREFULLY AND SIGN
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I understand that nothing contained in this application, or conveyed during any interview which may be granted is intended to create an employment contract. I understand that filling out this form does not indicate there is a position open and does not obligate Squeeze to hire me. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
APPLICANT'S SIGNATURE____________________________________________DATE_________________________
Page 2 of 2
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