Employment Opportunities

First name*

Last name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long have you been at this address?

Social Security No.

Date of Birth

If under 18, please list age

Phone*

Email*

Position applied for

Salary Desired

Employment desired

Full-Time
Part-Time Only
Full- or Part-Time

When are you available for work?

How many hours can you work weekly?

Can you work nights?

Number of years completed:

High School

College

Bus. or Trade School

Professional School

Have you ever been convicted of a crime?

No
Yes

If yes, explain number of convictions, nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Do you have a driver's license?

Yes
No

What is your means of transportation to work?

Driver's license number

State of issue

Operator
Commercial (CDL)
Chauffeur

Expiration Date

Have you had any accidents during the past three years? How many?

Have you had any moving violations during the past three years? How many?

Computer

Yes
No

Programs:

Excel
Word

Other

Please list two references other than relatives or previous employers.

References 1

Name

Position

Company

Phone

References 2

Name

Position

Company

Phone

Have you ever been in the armed forces?

Yes
No

Are you now a member of the National Guard?

Yes
No

Specialty

Date Entered

Discharge Date

Work Expierence

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of last supervisor

Employment Dates

Phone

Your last job title

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

Reason for leaving (be specific)

Name of employer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of last supervisor

Employment Dates

Phone

Your last job title

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

Reason for leaving (be specific)

Upload additional pages

May we contact your current employer?

Yes
No

Of the following categories, in which would you say you offer the most expertise:

Upload your resume

If you are hired you may terminate employment with Liberty Pawn and Gold for any reason or no reason. Liberty Pawn and Gold may terminate your employment for any reason or no reason. I also understand and agree that the first 2 weeks of employment are a trial period where either party may terminate employment without any repercussions from either part.

Signature

Printed Name

Name

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