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Telephone Number, day:
Name:
Telephone Number, evening:
Address:
Previous Address(es), (at least the last 5 years):
Email Address:
Are you over the age of 18? Yes No, what is your age?
Are you a previous applicant? Yes, when & Where? No
Are you a previous employee of Manley's Mighty Mart? Yes, when, where? No
Are You eligible to work in the United States? Yes No Proof will be required before an applicant can be employed.
Were you referred to Manley's Mighty Marts? Store Sign News Ad Outdoor Banner Employee:
Position applying for:
Part-Time Full-Time
How many hours do you wish to work?
Wages required:
Are there days of the week you cannot work? Yes, when? No
Do you have relatives or friends working for Manley's? Yes No If yes, who? Relationship? What store?
Do you have a license to drive in the United States? Yes, which state? No
Type of license:
Education - Check the last school year completed:
9 10 11	12 GED
College:
FR SO JR	SR Post
High School:
College:
Other (trade, graduate, etc.):
Please list any other education, training, certificates, licenses or special skills that are related to the job for which you are applying:
The secretary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, giardia, and compylobacter may prevent you from serving food or handling food equipment in a sanitary and healthy fashion. An essential function of this job involves handling food, food service equipment and utensils in a sanitary and healthy fashion. Is there any reason why you cannot perform the essential functions of this job?
Yes, explain: No
Have you ever been convicted of, pled guilty, or pled no contest or nolo contendre to a crime other than a minor traffic violation? Do not include convictions upon which your record was sealed or expunged.
Yes No
Please Note: A conviction will not necessarily be an automatic bar to employment. Factors such as the type and seriousness of the crime, the frequency of the violations, your age at the time, your entire work and education history, and the nature of the job sought will be taken into consideration. To help us evaluate your application, please describe the nature of the crime(s), when it occurred and your subsequent rehabilitation:

Employment Records - Give Present or Last Employer First:
1. Company Name & Address:
Telephone number
Date Employed:
To (end date):
Type of Business:
Starting Salary:
Ending Salary:
Job Title
Major Job Duties
Name of Supervisor:
May we contact this person? Yes No
Reason for Leaving:


2. Company Name & Address:
Telephone number
Date Employed:
To (end date):
Type of Business:
Starting Salary:
Ending Salary:
Job Title
Major Job Duties
Name of Supervisor:
May we contact this person? Yes No
Reason for Leaving:


3. Company Name & Address:
Telephone number
Date Employed:
To (end date):
Type of Business:
Starting Salary:
Ending Salary:
Job Title
Major Job Duties
Name of Supervisor:
May we contact this person? Yes No
Reason for Leaving:

Please initial at the end of each of the following paragraphs to indicate that you have read and understand the contents. An Equal Opportunity Employer In compliance with Federal and State equal employment opportunity laws, all qualified candidates will be considered for employment without regard to their race, creed, color, national origin, ancestry, gender, age, marital status, sexual preference, veteran status, or the presence of non job related medical conditions or disabilities. (initials ) Applicants Acknowledge and Agree to the Following: The distribution or receiving of this application by Manley's Mighty Marts does not imply or intend to imply an agreement or contract to employ the applicant. The purpose of this application is solely to allow persons a standard form on which to submit their qualifications. This application will be considered valid for no longer than six months. Re-application is a necessity after six months. (initials ) I authorize all persons, schools, employers, and organizations mentioned in this application to provide the Company with any and all job related information requested by the Company, and I voluntarily release such persons, schools, employers, and/or organizations from all liability for providing such information. (initials ) In the event that I am employed by the Company, I agree to abide by all the policies of Manley's Mighty Marts. I acknowledge that Manley's Mighty Marts reserves the right to amend or modify the policies of Manley's Mighty Marts at any time without prior notice. I also understand, that if employed, my employment is considered "at will" and may be terminated with or without cause, notice or liability, at any time, at my option or the option of the Company. I understand that no representation, whether oral or written, by any agent or representative of the Company, at any time, can constitute a contract of employment. (initials ) I understand that any falsification, misrepresentation, or omission of information requested on this application will be just cause for denial of employment or immediate dismissal. (initials ) I understand that as part of the procedure for my employment application an investigative consumer report may be made concerning my character, general reputation, personal characteristics, and mode of living. Upon written request, additional disclosure concerning the complete nature and scope of the investigation will be provided. If I am denied a job based either wholly or in part because of information contained in an investigative consumer report, I will be provided the name and address of the reporting agency that supplies the information. I certify that I am a genuine applicant for employment and that this application is being submitted solely for the purpose of seeking employment with Manley's Mighty Marts and for no other reason. (initials )

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