Employment Application

If you are a human and are seeing this field, please leave it blank.

Which Store are you Applying to?*

Personal Information

First Name*

Middle Initial*

Last Name*

Address*

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

Phone

Do you know anyone who works/has worked for us? Please tell us who.*

Referred by?

Desired Position

Title of Position*

Desired Salary/Wage*

Date You Can Start*

Are you currently employed?*

Yes
No

May we contact your current employer, if applicable?

Yes
No

Mighty Dollar operates on a 7 day work week. Are you available to work on all 7 days of the week?*

Yes
No

Education Background

High School

High School Name*

Address

Address City State / Province / Region ZIP / Postal Code

Still Attending?

Date Started?*

Date Ended?*

Did you Graduate?*

Yes
No

Subjects (if applicable)

College

College Name

Address

Address City State / Province / Region ZIP / Postal Code

Date Started?

Date Ended?

Did you Graduate?

Yes
No

Subjects (if applicable)

Other School

Type

Address

Address City State / Province / Region ZIP / Postal Code

Date Started?

Date Ended?

Did you Graduate?

Yes
No

Subjects (if applicable)

Special Interests

U.S. military or naval service?*

Yes
No

Special Skills/Training

Employment History

Please provide Start/End dates, Name and Address of Employer(s), Ending Salary, Position Held and Reason for leaving*

Have you ever been discharged or forced to leave any job?*

Yes
No

If yes, please explain

Have you ever been subject to formal disciplinary action at any prior employment?*

Yes
No

If yes, please explain

References

Reference #1

Full Name*

Address*

Address City State / Province / Region ZIP / Postal Code

Phone*

Type of Business*

Years Known*

Reference #2

Full Name*

Address*

Address City State / Province / Region ZIP / Postal Code

Phone*

Type of Business*

Years Known*

Reference #3

Full Name*

Address*

Address City State / Province / Region ZIP / Postal Code

Phone*

Type of Business*

Years Known*

Authorization

I certify the foregoing answers on this application are true, accurate, and correct to the best of my knowledge and understand any false information, incomplete or deceptive response, misstatement or omission as to any fact will constitute grounds for my immediate dismissal or rejection of my application. I authorize investigation of all statements contained herein and the references and employers listed within to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and I release the company for all liability for any damage that may result from use of said information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.The following question asks about convictions for crimes or service probation resulting from criminal charges. If you have ever been convicted (no matter the year) please list this information. Failure to indicate this information may cause future termination or not allow us to consider you for employment.

Have you ever been convicted of a crime (misdemeanors or felonies, including any guilty, no contest, or similar pleas) or served probation (as a result of deferred prosecution, pretrial intervention, or other similar agreement)?

Yes
No

If yes, please explain

Are you a citizen of the United States?*

Yes
No

If no, have you received authorization from the US Immigration and Naturalization Service to work in the US?

Yes
No

**Appropriate documentation will be required prior to employment

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