APPLICATION FOR EMPLOYMENT
In compliance with Federal and State equal employment opportunity laws, qualified applicants are
considered for all positions without regard to race, color, religion, sex, national origin, age, marital
status, or the presence of a non-job-related medical condition or handicap.
Email address *
Full Name *
Phone number *
Secondary Phone number
Full Address (including city, state, & zip code) *
Position applied for (check all that apply) *
Required
Are you at least 18 years of age? *
Are you looking for part time or full time? *
Are you able to lift 50 pounds as a part of your responsibilities? *
Do you have a legal right to be employed in the U.S.? *
Have you ever pleaded guilty, no contest or been convicted of a crime? *
If you answered yes on the previous question, please explain
If any of your friends or relatives work here list the name(s)
What is your highest level of education *
Required
Experience
Use the sections below to list all relative employment with the latest being first
Employment 1
Company Name and Location
approximate start date
MM
/
DD
/
YYYY
approximate end date
MM
/
DD
/
YYYY
Reason for leaving
Supervisor
Position
Last pay rate before leaving
Employment 2
Company Name and Location
approximate start date
MM
/
DD
/
YYYY
approximate end date
MM
/
DD
/
YYYY
Reason for leaving
Supervisor
Position
Last pay rate before leaving
Additional Employment
If you have additional past employment that you feel is relevant, please list them below adding Company Name, Position, and number of months or years at position.
List any additional employment
Skills and experience
Please rate the following experience or skills as it relates to you. 5 means excellent while 1 means could use improvement.
How would you rate your speed at learning new things? *
How would you rate your ability to manage yourself without being told what to do?
Clear selection
How would you rate your communication skills?
Clear selection
How would you rate your ability to multitask between tasks?
Clear selection
Are there any additional experiences or qualifications which you feel would especially fit you to work at Mad Mike’s? *
By Submitting this form you agree that all the information above is accurate and to your best knowledge.
I hereby, affirm that my answers to the foregoing are true and accurate. I understand that any misrepresentation of facts contained herein is sufficient cause for dismissal. I authorize the investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information
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