Preliminary Employment Application

Name:

Date:

Address:

City:

State:

Zip:

Social Security #:

Over 18 Yrs.:

Position Applying For:

Date Available:

Hours/Days Available:

(Must maintain an average of 30 or more hours per week.)

(Is not required to maintain an average of 30 or more hours per week.)

(Employee stipulates times and days him or her is available to work.)

Employment History:

Starting with most recent, please list previous employment.

Company Name:

Company Name:

Company Name:

Supervisor/Contact:

Supervisor/Contact:

Supervisor/Contact:

Dates Employed:

Dates Employed:

Dates Employed:

Position:

Position:

Position:

Phone:

Phone:

Phone:

Reason Leaving

Reason Left:

Reason Left:

Personal References:

List 3 people not related to you, whom you have known at least 1 year.

Name:

Name:

Name:

Phone:

Phone:

Phone:

Yrs Acquainted:

Yrs Acquainted:

Yrs Acquainted:

Have you ever been convicted of a felony?:

Do you have a valid drivers license?:

Do you have current automobile insurance coverage?:

*You must maintain a valid drivers license and automobile insurance coverage at all times to be eligible to work at Advantage.

**Please note that this is a preliminary employment application only.  You may be asked to complete a full application.  Neither application constitutes an employment offer, contract, or modification to the at-will employment relationship between yourself and Advantage.

Contact Information:

Please list how we can contact you.

Home Phone:

Cell Phone:

E-mail Address: