23 Main Street
Northampton, MA 01060

413-584-8666

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Job Application

Personal Information

Full Name:
Social Security #:
Present Address:
Permanent Address:
Personal Phone:
Other Phone:
E-mail:
Have you ever worked under another name?  Yes No
If yes, list:
Position Desired:
Salary Expected:
I Can Work:
Full Time
Part Time
Temporary
Permanent
Times Available:
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
    Days
Evenings
Nights
Holidays
Overtime
Split Shifts
Any Time
 
Employment Record

Record your most recent position first. Failure to accurately account for all periods during the last seven years may lead to your application not being considered. If omissions or falsifications are discovered subsequent to your employment, such omissions or falsification will be sufficient cause for discharge (List periods of school as follows: School name under company name & dates attended.)

Have you ever worked for Fitzwilly's before? Yes No
If yes, when?
Have you ever applied to Fitzwilly's before? Yes No

Employer #1 (most recent)


Company Name:
Company Address:
Supervisor Name:
Phone Number:
Job Titles & Duties:
Reason for Leaving:
Starting Date:  Ending: 
Starting Wage:  Ending: 
Were you unemployed between positions?  Yes No
How long and why?

Employer #2

Company Name:
Company Address:
Supervisor Name:
Phone Number:
Job Titles & Duties:
Reason for Leaving:
Starting Date:  Ending: 
Starting Wage:  Ending: 
Were you unemployed between positions?  Yes No
How long and why?

Employer #3

Company Name:
Company Address:
Supervisor Name:
Phone Number:
Job Titles & Duties:
Reason for Leaving:
Starting Date:  Ending: 
Starting Wage:  Ending: 
Were you unemployed between positions?  Yes No
How long and why?
Have you ever been asked to resign or been fired for cause? Yes No
May we contact your previous employers? Yes No
Please list any previous employers you wish us not to contact:
 
 Educational Record

Years Completed:
High School Name:
Degree Received:
Course Work:
Trade School Name:
Degree Received:
Course Work:
College Name:
Degree Received:
Course Work:
 
 Other Information

Outside Activities or Hobbies:
If you have any friends or relatives currently working at Fitzwilly's please list their names and their relationship to you:
Are you older than 18?   Yes No
Are you older than 21?   Yes No
Do you have reliable transportation to get to and from work? Yes No
Have you ever been denied a bond?   Yes No
Have you ever been convicted of a felony or misdemeanor other than a traffic violation?   Yes No
If yes, please explain:
(Such conviction may be relevant if job related, but does not bar you from employment.)
Military Service
Are you now, or have you ever been in the military?   Yes No
If yes, list branch of service and highest rank attained:
If in reserves, are you currently active?   Yes No
Immigration Status
If an alien, do you have a legal right to be in the U.S.?   Yes No
If an alien, do you have a legal right to accept employment in the U.S.?   Yes No
(Upon employment, verification of legal employment status will be required.)
 
 References

Name:
Title:
Phone:
Years Known:
Name:
Title:
Phone:
Years Known:
Name:
Title:
Phone:
Years Known:
 
 Important! Please Read Carefully

I hereby authorize investigation of all statements contained in this application, including inquiry of any and all of my former employers or references as indicated elsewhere on this application, and hold said former employers and/or references harmless from liability arising therefrom. I affirm that all the information contained in this application is true and correct, and that any misrepresentation, falsification or omission herein shall be sufficient reason for dismissal from, or refusal for employment. If employed, I understand that the company reserves the right to modify or terminate my employment at any time, with or without cause, and without prior notice. I further understand that the duration, hours, nature, compensation and benefits of my employment may be changed or modified from time to time without limitation or condition. I understand that no representative of the company has any authority to make any assertions to the contrary. I hereby agree to abide by all policies and rules of this company which govern dress, hair, grooming and attitude.

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