FurnitureLand, Inc.
38529 Sussex Highway - Delmar, DE 19940
Employment Application
Applicant Information
Full Name:
Date:
Address:
Apt/Unit #:
City:
State:
Zip Code:
Email:
Phone:
Date Available:
Soc. Sec. #
Desired Salary: $
Position Applied:
Are you a U.S. Citizen?
Yes
No
If no, are you authorized to work in the U.S.? Yes
No
Have you worked for
this company?
Yes
No
If so, when?
Have you ever
been convicted of
a felony?
Yes
No
If yes, explain?
Driver's License:
State:
License #:
Education
High School:
Address:
From:
To:
Did you Graduate? Yes
No
Degree:
College:
Address:
From:
To:
Did you Graduate? Yes
No
Degree:
Other:
Address:
From:
To:
Did you Graduate? Yes
No
Degree:
References
Please list three professional references.
Full Name:
Relationship:
Company:
Phone:
Address:
Full Name:
Relationship:
Company:
Phone:
Address:
Full Name:
Relationship:
Company:
Phone:
Address:
Previous Employment
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Repsonsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference? Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Repsonsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference? Yes
No
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Repsonsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference? Yes
No
Military Service
Branch:
From:
To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. As part of this application for employment, I hereby authorize the company to investigate my references and to make an independent investigation of my character, conduct and employment records. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Please check this box to agree to the above statement:
*
Date:
* Indicates required field