Application For Employment

As an Equal Opportunity Employer, this organization does not discriminate on the basis of race, color, religion, sex, national origin, age, disability or veteran status. All information provided in this application will be treated confidentially and will be used only to help ensure the best use of your abilities if you are employed by us.

Please fill out the following form to the best of your ability.

Email Address   City
First Name   State
Middle Name   Zip
Last Name   Phone 1
Address 1   Phone 2
Address 2   Other
How did you hear about Wickersham Jewelry?
What location are you applying for?
Date available for work?
Type of employment desired? Full-time  Part-time  Temporary  Seasonal  Co-Op
If under 18, can you furnish a work permit? Yes No
Have you ever been employed here before? Yes No
Are you legally eligible for employment in this country? Yes No
Are you employed? Yes No
Are you able to meet the attendance requirements for this position? Yes No
Have you ever been convicted of a felony in the last seven years? Yes No
If yes, please explain:

Conviction will not necessarily be a bar to employment each instance/explanation will be viewed in relation to the position you are applying.
What is your desired salary range or hourly rate of pay? $ Per

Skills and Qualifications

Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

Educational Background

If job related

Education Name & City Years Completed Graduate? Course of Study
High School   Yes No   
College   Yes No   
Trade, Business, or Other   Yes No   

References

Please list three business references/work references who are not related to you or who are not friends.

  Name Address Phone Number Business Years Known
Reference 1
Reference 2
Reference 3

Employment History

Provide the following information for your past employers, assignments or volunteer activities, starting with the most recent.

From To Employer Telephone
Job Title Address
Immediate Supervisor Summarize the nature of your
work / responsibilities
Reason for Leaving Hourly Rate/Salary Start $ Per     
Final $ Per

From To Employer Telephone
Job Title Address
Immediate Supervisor Summarize the nature of your
work / responsibilities
Reason for Leaving Hourly Rate/Salary Start $ Per     
Final $ Per

From To Employer Telephone
Job Title Address
Immediate Supervisor Summarize the nature of your
work / responsibilities
Reason for Leaving Hourly Rate/Salary Start $ Per     
Final $ Per


BY SUBMITTING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS.

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