Wayside Country Store Employment Form

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WAYSIDE COUNTRY STORE EMPLOYMENT APPLICATION
AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

Year round employment. We do not hire just summer or holidays

Date:
Last Name: First Name: Middle Initial:
Email Address:
Home Phone Number: Cell Phone Number:
Street City State Zip Code



Are you over the age of 14? Yes No

Are you a previous applicant? Yes No - If yes When?: Where?:

Are you a previous employee of the Wayside Country Store? Yes No - If yes From?: To?:

Are you a citizen or an alein legally authorized to work in the United States? Yes No - If NO - When?: Where?:
(if hired, you must be able to submit verification of your identity and legal right to work in the United States.)

Position Applied For:
Part Time
Full Time

(Wayside Country Store will endeavor to make a reasonable accommodation to the known physical and mental limitations of a qualified applicant or employee with a disability unless the accommodation would impose an undue hardship on the operation of the business).

Wages Required?
Amount per hour: or Amount per week:

Normal Store Hours:
Mon-Wed 10am to 5pm
Thurs-Sat 10am to 6pm
Sunday 10am to 5pm


Please check box next to all the days and type in the hours that you can work:
(It is necessary to identify, at this tie, restrictions to availability that are because of religious observances)

Monday
Time:

Tuesday
Time:

Wednesday
Time:

Thursday
Time:

Friday
Time:

Saturday
Time:

Sunday
Time:

Referred by:? Self Store Sign Employee Advertisement School Friend Other - State if Other:

Please list any relatives currently employed at Wayside Country Store (It is our policy to avoid Nepotism or other conflicts of interest that are business-related.)

FOR APPLICANTS FOR POSITIONS LOCATED IN MASSACHUSETTS ONLY:
Have you ever been convicted of a felony? Yes No
Within the last 5 years, have you been convicted of, or released from incarceration for a misdemeanor which was not a first offense for drunkenness, simple assault speeding, a minor traffic violation, and affray, or disturbing the peace? Yes No

PLEASE NOTE: A Conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe the nature of the crime(s), when it occurred and your subsequent rehabilitation.



Name of responsible party in case of emergency

Name: Relationship: Phone:

What year are you in school?
Are you able to work after school? Yes No
Are you able to work weekends? Yes No
Are you able to work holidays? Yes No
Are you currently employed? Yes No
Company Name: Phone:

Contact Person: Starting Salary:

Major Duties: Reason for Leaving:

Do you know any one presently employed at Wayside Country Store? Yes No
Who:
Personal Reference (Not related to you)
Name: Phone #:
Name: Phone #:
Name: Phone #:

Anything else you would like to add:


IMPORTANT: READ CAREFULLY

Information contained in this application is correct to the best of my knowledge and I understand that falsification and / or omission of this information may result in dismissal in accordance with the company policy. The company in considering my application for employment may verify the information set forth on this application and obtain additional information relating to my background. I authorize all persons, schools, companies, corporations, credit bureaus and law enforcement agencies to supply any information concerning my background, and release all parties from all liability for any demage that my first 30 days of employment is considered to be a probationary period, and thereafter at will, during which time my employment and compensation can be terminated, with or without any notice, at any time, at the option of either the company or myself.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE

Applicant's Signature: Date:





Please enter the following code into the box provided: