APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
Name ( Last, First )
Present Address
City
State
Zip
Permanent Address
City
State
Zip
Home Phone
Cell Phone
E-Mail Address
EMPLOYMENT DESIRED
Position
Date you can Start
Salary Desired
Are you Employed?
Yes
No
If so, may we inquire of your present employer?
Yes
No
*
Which Location are you applying for?
Fort Worth
Southlake
Either
Ever applied to this company before?
Yes
No
Where?
When?
If you are applying for a service provider position, do you have your current license from the Texas Department of licensing and Regulation?
Yes
No
If No, when do you expect to receive your license?
If Yes Type of Professional license(s) you have?
Cosmetologist
Esthetician
Massage Therapist
Shampoo Technician
Other
If Other Name:
Please give a description of the Days and Times you will be available to work.
FORMER EMPLOYERS
Date
Month & Year
Name & Address of
Employer
May we
Contact?
Salary
Position
Reason for
leaving
From:
Yes
No
To:
From:
Yes
No
To:
From:
Yes
No
To:
EDUCATION
Name of School
Area of degree / Study
Diploma / Certificate of Completion Received?
High School
Yes
No
Trade School and/or College
Yes
No
Trade School and/or College
Yes
No
REFERENCES
Give below the names of three persons not related to you, whom you have known at least one year.
Name
Phone #
Business
Years Known
* Indicates Fields that MUST be Answered.
AUTHORIZATION
“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 Americans with Disabilities Act (ADA) and other federal and state laws.”