Get A Grip Employment Application Form

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE

I-70
Columbia, MO
[email protected]
APPLICATION FOR EMPLOYMENT
APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

PLEASE COMPLETE PAGES 1-5.

DATE ________________________________

Name _____________________________________________________________________________________________
Last

First

Middle

Maiden

Present address _____________________________________________________________________________________

Number

Street

State

Zip

Social Security No. _______ _____ _________

How long ____________________

Telephone (

City

If under 18, please list age ____________________

Days/hours available to work
No Pref ______ Thur _________
Mon _________ Fri _________
Tue _________ Sat _________
Wed _________ Sun ________

Position applied for (1) _______________________

and salary desired (2) ______________________
(Be specific)
How many hours can you work weekly? ________________________
Employment desired

FULL-TIME ONLY

Can you work nights? ______________________

PART-TIME ONLY

FULL- OR PART-TIME

When available for work? _______________

___________________________________________________________________________________________________

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing
address)

NUMBER OF YEARS
COMPLETED

MAJOR &
DEGREE

High School
College
Bus. or Trade School
Professional School

HAVE YOU EVER BEEN CONVICTED OF A CRIME?

No

Yes

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

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE

I-70
Columbia, MO
[email protected]
APPLICATION FOR EMPLOYMENT

DO YOU HAVE A DRIVERS LICENSE?

Yes

No

What is your means of transportation to work? ______________________________________________________________

Drivers license
number ____________________________ State of issue _______
Chauffeur
Expiration date ______________________

Operator

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

Commercial (CDL)

How many? __________________

How Many? __________________

OFFICE ONLY

Typing

Yes
No

Personal
Computer

Yes
No

_____ WPM
PC
Mac

Yes
10-key No

Word
Processing

Yes
No

_____ WPM

Other ____________________________________________
Skills ____________________________________________

Please list two references other than relatives or previous employers.

Name _______________________________________

Name ___________________________________________

Position ______________________________________

Position __________________________________________

Company ____________________________________

Company ________________________________________

Address _____________________________________

Address _________________________________________

______________________________________

__________________________________________

Telephone (

Telephone (

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the
space below to summarize any additional information necessary to describe your full qualifications for the specific position for
which you are applying.

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE

I-70
Columbia, MO
[email protected]
APPLICATION FOR EMPLOYMENT
MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?

Yes

No
Yes

No

Specialty __________________________________ Date Entered ________________ Discharge Date _____________

Work
Experience

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
City, State, Zip Code
Phone number

Name of last
supervisor

Employment dates

Pay or salary

From

Start

To

Final

Your last job title

Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

Name of employer
Address
City, State, Zip Code
Phone number

Name of last
supervisor

Employment dates

Pay or salary

From

Start

To

Final

Your Last Job Title

Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE

I-70
Columbia, MO
[email protected]
APPLICATION FOR EMPLOYMENT

Work
experience

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
City, State, Zip Code
Phone number

Name of last
supervisor

Employment dates

Pay or salary

From

Start

To

Final

Your last job title

Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

Name of employer
Address
City, State, Zip Code
Phone number

Name of last
supervisor

Employment dates

Pay or salary

From

Start

To

Final

Your last job title

Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this
company.

May we contact your present employer?

Yes

No

Did you complete this application yourself

Yes

No

If not, who did? ______________________________________________________________________________________

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by ___________________ (hereinafter called the
Company), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment
relationship, either in the position applied for or any other position, and regardless of the contents of
employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist
from time to time, or other Company practices, shall serve to create an actual or implied contract of
employment, or to confer any right to remain an employee of Get A Grip, or otherwise to change in any
respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be
altered except by a written instrument signed by the President /General Manager of the Company. Both the
undersigned and Get A Grip may end the employment relationship at any time, without specified notice or
reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies
and procedures and such changes may include reduction in benefits.
I authorize investigation of all statements contained in this application. I understand that the
misrepresentation or omission of facts called for is cause for dismissal at any time without any previous
notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise
indicated), references, and others, and hereby release the Company from any liability as a result of such
contract.
I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment
testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of
my employment; and (3) continued employment is based on the successful passing of testing under such
policy. I further understand that continued employment may be based on the successful passing of
job-related physical examinations.
I understand that, in connection with the routine processing of your employment application, the Company
may request from a consumer reporting agency an investigative consumer report including information as to
my credit records, character, general reputation, personal characteristics, and mode of living. Upon written
request from me, the Company, will provide me with additional information concerning the nature and scope
of any such report requested by it, as required by the Fair Credit Reporting Act.
I further understand that my employment with the Company shall be probationary for a period of sixty (60)
days, and further that at any time during the probationary period or thereafter, my employment relation with
the Company is terminable at will for any reason by either party.

Signature of applicant__________________________________________ Date: ___________________

This Company is an equal employment opportunity employer. We adhere to a policy of making employment
decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or
disability. We assure you that your opportunity for employment with this Company depends solely on your
qualifications.

Thank you for completing this application form and for your interest in our business.

PLEASE PRINT ALL

INFORMATION REQUESTED
EXCEPT SIGNATURE
POST EMPLOYMENT INFORMATION FORM
TO BE COMPLETED AFTER EMPLOYEE HAS BEEN HIRED
Height ______ ft. ______ in.
Married Yes

No

Weight __________
Single

If married, how long? _____

Birth date _______________

Separated

Divorced

Widowed

Full name of spouse ________________________________

Occupation _____________________________________

Name of company __________________________________

Telephone (

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

Name

__________________________________________

Address _________________________________________

Telephone (

Relationship _____________________________________

FOR INSURANCE PURPOSES ONLY: LIST ALL DEPENDENTS

NAME

RELATIONSHIP

BIRTH DATE

SSN

TO BE COMPLETED
BY EMPLOYER

Date of employment

_________________

Location ____________________________
Salaried

Job title ____________________ Dept. ____________________________

Rate of pay _________________

Full-time

Part-time

Applicants signature acknowledging above information _______________________________________________________

Drug test confirmation number _______________________________
Name of person verifying information _____________________________________________________________________
Name of person authorizing employment __________________________________________________________________

Applicant Selection Criteria Record

JOB TITLE

CANDIDATES CONSIDERED (INCLUDING MINORITIES AND FEMALES)

NAME

MALE/

ETHNIC

FEMALE

CODE*

ON LAB
SECTION/ OFF
LAB

*ETHNIC CODES: 1-BLACK, 2-ORIENTAL, 3-HISPANIC, 4-AMERICAN INDIAN, 0-OTHER

CANDIDATE SELECTED
NAME

MALE/

ETHNIC

FEMALE

CODE

SOURCE

SELECTION CRITERIA

REASONS CANDIDATE SELECTED WAS PREFERABLE TO OTHERS

ORIGINATOR'S SIGNATURE

DATE