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 Kishman's IGA Application Form

Prospective employees will receive consideration without discrimination due to race, creed, color, sex, age, national origin, handicap or veteran status.
 
PERSONAL INFORMATION
Name
 		 Address
 
City
 		 State
 		 Zip  
Telephone
 		   E-Mail Address
If you are under 18, please enter your age:  
Is this your first application with  Kishman's Yes No
Have you ever been interviewed by Kishman's Yes No
What type of work are you applying for:  
When can you start work?    
Are you currently employed: Yes No
Expected earnings: $             per hour
This application is for: Part Time Full Time
If full time is not available,
would you accept part time:		 Yes No
List any hours you would be unable to work?
Have you ever been convicted
of a felony or misdemeanor?		 Yes No
If yes, please describe:
EDUCATION
Type of School Name and Location Graduate? Course or Degree
High School Y N
Bus., Trade or Vocational Y N
College Y N
Other Y N
WORK HISTORY
Most recent employer

Please list your former employers, beginning with the most recent.

Company
 		Address
Type of Business
 Employ Date
 Job Title
 Start Pay
 End Pay
Supervisor's Name and Title
 		May we contact this employer?
 Yes  No
Supervisor's Phone
 		Start Date
 		Leave Date
 		 
Why did you leave?
 
2nd most recent employer
Company
 		Address
Type of Business
 Employ Date
 Job Title
 Start Pay
 End Pay
Supervisor's Name and Title
 		May we contact this employer?
 Yes  No
Supervisor's Phone
 		Start Date
 		Leave Date
 		 
Why did you leave?
 
3rd most recent employer
Company
 		Address
Type of Business
 Employ Date
 Job Title
 Start Pay
 End Pay
Supervisor's Name and Title
 		May we contact this employer?
 Yes  No
Supervisor's Phone
 		Start Date
 		Leave Date
 		 
Why did you leave?
 
4th most recent employer
Company
 		Address
Type of Business
 Employ Date
 Job Title
 Start Pay
 End Pay
Supervisor's Name and Title
 		May we contact this employer?
 Yes  No
Supervisor's Phone
 		Start Date
 		Leave Date
 		 
Why did you leave?
 
MILITARY SERVICE
Were you in the U.S. Armed Forces?  Yes No
If yes, what Branch?
Dates of duty:
From:    To:
Rank at Discharge:
List your duties and skills while in the service:
REFERENCES
People who know you well that can be contacted
Name
 		Occupation
Address
 		Phone
Name
 		Occupation
Address
 		Phone
Name
 		Occupation
Address
 		Phone
INFORMATION VERIFICATION
The information provided in this application for employment is true, correct and complete. If employed, any misstatement or omission of facts on this application may result in dismissal.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future.

I authorize Kishman's to contact and/or verify my employment, references or any other background information. Further, I hereby release from all liability or damages those individuals, corporations or organizations who provide such information.
Date:             

Electronic Signature
By checking this box and clicking "Submit employment application to  Kishman's, I electronically sign and submit this application to  Kishman's