APPLICATION FOR EMPLOYMENT
EQUAL OPPORTUNITY EMPLOYER
We are an Equal Opportunity Employer. We consider applicants for all positions without regard to race, color, creed, religion, sex, national origin, age,
marital or veteran status, the presence of a non-job-related medical condition or handicap, and any other legally protected status. It is our policy to abide
by all Federal, State, and local laws concerning discrimination in employment. No question in this application is intended to elicit information in violation
of any such law nor will any information obtained in response to any question be used in violation of any such law
PERSONAL INFORMATION
Date Of Birth
Date available to start
Are you a citizen of the USA ?
Yes
No
How long at present address ?
Are you employed ?
Yes
No
If no, explain
Valid drivers license number
Driver license state
Employment desired
Part Time
Full Time
Have you ever been convicted of any law violation
( other than a minor traffic violation ) ? A Yes answer
does not automatically disqualify you from employment
since the nature, date, and job you are applying for will be
considered
Yes
No
If yes, explain
EDUCATION AND TRAINING
Did you graduate?
Yes
No
Last year
List any other education, training, special skills
How many hours of a night would you like to work?
What area is accommodating for you?
Concord NC
Kannapolis NC
Huntersville NC
Midland NC
Charlotte NC
Out of the 7 days in a week what days would accommodate you?
MON
TUS
WEN
THU
FRI
SAT
SUN
PRESENT EMPLOYER.
Starting Date
Ending Date
Reason for leaving
FORMER EMPLOYER.
Starting Date
Ending Date
Reason for leaving
AUTHORIZATION AND SEND -- PLEASE READ CAREFULLY BEFOR SENDING
By Sending I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if falsified statements on this application or interview shall be grounds for dismissal. I authorize investigation of all statement contained herein and the reference 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. I also understand that Libby's Clean
Shine requires a background check on all perspective employees.
Send
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