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A DISCOUNT SHOPPING ADVENTURE.
Employment Application
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including
race, sex, religion, national or ethnic origin, age, veteran status, handicap or sexual orientation. Applicants may be tested
for illegal drugs.
(Please print all information requested)
Position Applied for: Date of Application:
First Name: Middle Name: Last Name:
Street Address: City: State: Zip:
Phone: Mobile: Fax:
Social Security Number: Date of Birth:
Date Available to Start: Type of Employment desired: Full-Time Part-Time
Have you ever been employed here before: Yes No When?
Have you ever been fired from a job? Yes No Explain Circumstances:
If hired can you provide the proof of being eligible to be employed in the United States? Yes No
Have you ever been convicted of a felony or misdemeanor? Yes No If Yes, how many? Recent date:
Explain:
Education
Name and Location of School (city, state) Check last year completed Graduated? Subjects Studied or Degrees
Yes
High School 1 2 3 4
No
Technical Trade Yes
1 2 3 4
after High School No
Yes
1 2 3 4
No
College
(list all attended) Yes
1 2 3 4
No
Other Training
School Name:
Location (city, state)
Subjects of Special Study:
Dates Attended: From To
Outside Activities Professional memberships, or licenses held. (Exclude those indicating race, color, religion, sex, national origin, age, or handicap.)
Employment Application page 2
(Please print all information requested)
Computer Skills
Hardware:
Software:
Please list other skills and/or equipment/language experience you have acquired:
Military Record (if apply)
Branch of Service: From: To:
Present Military Affiliation: None Reserve (active) Reserve (inactive)
Kinds of Training and Duty While in Service:
Employment History
Employer: Position:
Address: Start Date:
City: State: Zip: End Date:
Phone: Supervisor’s Name: Supervisor’s Title:
Reason for leaving:
List jobs you held, duties performed, skills used or learned or promotions while you worked at this company:
May we contact this employer: Yes No
Employer: Position:
Address: Start Date:
City: State: Zip: End Date:
Phone: Supervisor’s Name: Supervisor’s Title:
Reason for leaving:
List jobs you held, duties performed, skills used or learned or promotions while you worked at this company:
May we contact this employer: Yes No
Employment Application page 3
(Please print all information requested)
Employment History
Employer: Position:
Address: Start Date:
City: State: Zip: End Date:
Phone: Supervisor’s Name: Supervisor’s Title:
Reason for leaving:
List jobs you held, duties performed, skills used or learned or promotions while you worked at this company:
May we contact this employer: Yes No
Employer: Position:
Address: Start Date:
City: State: Zip: End Date:
Phone: Supervisor’s Name: Supervisor’s Title:
Reason for leaving:
List jobs you held, duties performed, skills used or learned or promotions while you worked at this company:
May we contact this employer: Yes No
In case of an emergency, list two persons whom we may contact:
Name: Phone: Relation:
Address:
Name: Phone: Relation:
Address:
Employment Application page 4
Authorization
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand
that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed,
no matter when discovered by Surplus City.
I understand that any employment is conditioned on a background check. I authorize Surplus City to thoroughly investigate all statements contained in
my application or resume, and I authorize my former employers to disclose information regarding my former employment, character and general
reputation to Surplus City, without giving me prior notice of such disclosure. In addition, I release Surplus City and any former employers listed above
from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.
I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract.
I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or
without cause and without prior notice, at the option of either myself or Surplus City. No promises regarding employment have been made to me, and
I understand that no such promise or guarantee is binding upon Surplus City unless made in writing.
If I am offered employment I agree to submit to a medical examination and drug testing before starting work. If employed, I also agree to submit to a
medical examination or drug test at any time deemed appropriate by Surplus City and as permitted by law. I consent to such examinations and tests,
and I request that the examining doctor disclose to Surplus City results of the examination, which results shall remain confidential and segregated from
my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical
examinations and drug tests, and if I am hired a condition of my employment will be that I abide by Surplus City’s Drug and Alcohol Policy.
I understand that filing out this form does not indicate there is a position open and does not obligate Surplus City to hire. If hired, I agree to abide by all
Surplus City work rules, policies and procedures. Surplus City retains the right to revise its policies or procedures, in whole or in part, at any time.
Signature: Date:
Applications can be faxed to 270.442.4662.
You may also deliver or mail your application and resume to: Surplus City . 1927 Irvin Cobb Drive . Paducah, KY 42003
P: 270.442.4772 . jobs@surpluscitydeals.com . www.surpluscitydeals.com
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