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Application for Employment

Thank your for considering Pinch A Penny, (and its affiliates hereinafter referred to as the "Company") in your job search. The Company is an equal opportunity employer and does not discriminate on the basis of sex, age, race, color, religion, national origin, mental or physical disability, sexual orientation, political affiliation, marital, veteran, or any status protected by law.

GENERAL INFORMATION EDUCATION EMPLOYMENT RECORD AGREEMENT
First Name:
Middle:
Last Name:
* Current Address:
Address:
Phone Number:

eg 7275551212
City:
State:
Zip:
SS#:
Drivers License:
Email:
* If at the above residence less than three years, list below all residences for the past three years.
Previous Address:
Address:
City:
State:
Zip:
Previous Address:
Address:
City:
State:
Zip:
Position Applying For:
Temp Part Time Full Time
Shift:
8AM - 5PM
Referred by?
Rate of Pay Desired
Are you 18 years of age or older?
Yes   No
Do you have the legal right to work in the United States?
(Successful applicants will be required to prove identity and eligibility for employment)
Yes   No
Have you ever worked for this company before?
Yes   No
From:
To:
Where?
Position
Reason for Leaving
Name of any relatives employed by this company
Are you currently employed?
Yes   No
If not, how long since leaving last employment?
Do you have experience in, or have you ever worked in a similar industry or business before? If so, explain. (including length of employment, position, industry)?
Yes   No
Have you ever been employed or attended school using any other name?
Yes   No
If yes, please explain:
Have you ever been CONVICTED, plead GUILTY, or NO CONTEST, or FORFEITED BOND OR BAIL for any crime other than traffic violations?
Yes   No
If yes, please explain:

(Conviction of a crime is not an automatic bar to employment. Factors such as the nature and gravity of the crime, the length of time that has passed since the conviction and/or completion of any sentence, and the nature of the job for which you have applied will be considered).
Are you able to perform the primary duties of the job as outlined in the newspaper advertisement, announcement, posting, job line, job description, etc., with or without reasonable accommodations?
Yes   No
If no, please explain:
Do you have any employment restrictions resulting from a non-compete or confidentiality agreement?
Yes   No
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