Summerhays Employment Application

Full Name *

Email Address *

Phone Number *

Social Security Number (Last four numbers only) *

Present Address *

Permanent Address *

Type of employment desired? *

Full-Time

Part-Time

Temporary

Seasonal

Position Desired *

Date you can start * +

Schedule Available Days & Hours *

	Mon	Tue	Wed	Thur	Fri	Sat
8am	Mon	Tue	Wed	Thur	Fri	Sat
9am	Mon	Tue	Wed	Thur	Fri	Sat
10am	Mon	Tue	Wed	Thur	Fri	Sat
11am	Mon	Tue	Wed	Thur	Fri	Sat
12pm	Mon	Tue	Wed	Thur	Fri	Sat
1pm	Mon	Tue	Wed	Thur	Fri	Sat
2pm	Mon	Tue	Wed	Thur	Fri	Sat
3pm	Mon	Tue	Wed	Thur	Fri	Sat
4pm	Mon	Tue	Wed	Thur	Fri	Sat
5pm	Mon	Tue	Wed	Thur	Fri	Sat
6pm	Mon	Tue	Wed	Thur	Fri	Sat
7pm	Mon	Tue	Wed	Thur	Fri	Sat

Salary Requirements *

Are you legally allowed to work in the United States? *

Yes

No

Ever applied to this company before? *

Yes

No

*

	Where	When
Previous Application	Where	When

Upload your resume *

Education History

Name & Location of High School

	Name	Location
High School	Name	Location

Name & Location of College

	Name	Location
College	Name	Location

Trade, Business, or Correspondence School

Degrees completed

Subjects Studied

Did you Graduate?

Yes

No

Years attended

Would you like to include additional education history? *

Yes

No

Additional Education History

Other Subjects Studied

Years attended

Did you Graduate?

Yes

No

Summarize Your Special Skills or Qualifications

Summary Comments *

Previous Employment (begin with most recent position)

Company Name

Position(s) Held

Dates of Employment:

From +

To +

Company Street Address

City

State

Zip Code

Phone Number

Supervisor Name & Title

	Name	Title
Supervisor	Name	Title

Responsibilities

Reason for Leaving

May we contact this employer for a reference?

Yes

No

Would you like to include additional employment history? *

Yes

No

Additional Employment History

Company Name

Position(s) Held

Dates of Employment:

From +

To +

Company Street Address

City

State

Zip Code

Phone Number

Supervisor Name & Title

	Name	Title
Supervisor	Name	Title

Responsibilities

Reason for Leaving

May we contact this employer for a reference?

Yes

No

Would you like to include additional employment history? *

Yes

No

Additional Employment History

Company Name

Position(s) Held

Dates of Employment:

From +

To +

Company Street Address

City

State

Zip Code

Phone Number

Supervisor Name & Title

	Name	Title
Supervisor	Name	Title

Responsibilities

Reason for Leaving

May we contact this employer for a reference?

Yes

No

References

Give below the names of three persons not related to you, whom, you have known at least one year *

	Name	Phone Number	Address	Business	Years Known
1	Name	Phone Number	Address	Business	Years Known
2	Name	Phone Number	Address	Business	Years Known
3	Name	Phone Number	Address	Business	Years Known

*

""I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize 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. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americas with Disabilities Act (ADA) and other relevant federal and state laws.”

Signature of Applicant

Type full name here as your official digital signature: *

Date * +