Careers

Are you 18 years or older?

Yes No

Are you currently employed?

Yes No

If so, may we contact your employer?

Yes No

Position applied for

Rate of pay expected (per hour)

Other Position(s) qualified for

Are you legally eligible for employment in the United States?

Yes No

Check shift(s) you can work

Special Licenses or Certifications

Expiration Date

Have you been convicted and/or plead guilty to a felony or misdemeanor?

Yes No

If yes, please provide us with the specific nature and details of the crime(s), date(s), court location, sentencing information and disposition of sentence. Please note: a conviction record will not necessarily be a bar from employment. If No, please put N/A.*

Do you have any pending criminal charges against you at this time?

Yes No

Have you ever been employed at Mattresses and Furniture?

Yes No

How were you referred to Mattresses and Furniture?

Education

Select you highest level of education completed

High School Attended*

College Attended

Other graduate, business, or vocational school, or other training skills

Employment Information

Name of Employer*

Employer Address*

Employer Phone*

Dates of employment. From*

To*

Starting Wage*

Type of Business*

Ending Wage*

Your Position/Title*

Supervisor*

Briefly describe your duties and responsibilities*

Name of Employer

Employer Address

Employer Phone

Dates of employment. From

Starting Wage

Type of Business

Ending Wage

Your Position/Title

Supervisor

Briefly describe your duties and responsibilities

Name of Employer

Employer Address

Employer Phone

Dates of employment. From

Starting Wage

Type of Business

Ending Wage

Your Position/Title

Supervisor

Briefly describe your duties and responsibilities

References

Full Name of Reference*

Reference Relationship*

Reference Company*

Reference Phone*

Reference Address*

Full Name of Reference*

Reference Relationship*

Reference Company*

Reference Phone*

Reference Address*

Full Name of Reference*

Reference Relationship*

Reference Company*

Reference Phone*

Reference Address*

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

By clicking the SUBMIT button you acknowledge and agree to the terms stated above. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Date*

Please type your name in the signature box below:*

Questionnaire

Education

Employment Information

References

Disclaimer and Signature