Little General Stores

Little_General

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Employment Qualification Consideration
GENERAL INFO
First Name
Middle Name
Last Name
Address
City
State
ZIP
Phone

Position(s) Applied For

EMPLOYMENT HISTORY
Begin with current or last job, include military service assignments. If you include volunteer activities, you may exclude organizations that indicate race, color, religion, national origin, disability, or other protected status.
1. Employer
Dates	From To
Duties or Responsibilties
Address
Wage Type	Hourly Salary
Pay Grade	Start Final
Job Title
Supervisor's Phone #
Reason for Leaving

2. Employer
Dates	From To
Duties or Responsibilties
Address
Wage Type	Hourly Salary
Pay Grade	Start Final
Job Title
Supervisor's Phone #
Reason for Leaving

3. Employer
Dates	From To
Duties or Responsibilties
Address
Wage Type	Hourly Salary
Pay Grade	Start Final
Job Title
Supervisor's Phone #
Reason for Leaving

EDUCATION
Education - Years Completed	6789101112 1416182022
Elementary School
Location
Diploma/Degree
Studies

High School
Location
Diploma/Degree
Studies

Trade/Professional School
Location
Diploma/Degree
Studies

College/University
Location
Diploma/Degree
Studies

Graduate School
Location
Diploma/Degree
Studies

Specialized Training, Apprenticeship, Extracurricular Activities
Honors, Awards, Copyrights, or Patents
Special Job-Related Skills and Qualifications from Employment or Other Experience

MILITARY HISTORY
Military Service	Yes No
When
Release/Type
Job Related Training
Current Status

PERSONAL
If under 18 years of age, can you provide proof of eligibility to work?	Yes No
Have you ever applied to work for Little General Stores, Inc before?	Yes No If yes, when?
Have you ever been employed by Little General Stores, Inc before?	Yes No If yes, when?
May we contact your present employer?	Yes No
Have you even been convicted of a crime other than a traffic violation? Conviction will not necessarily disqualify you from emplyment.	Yes No If yes, explain:
Are you currently on layoff status, subject to recall?	Yes No

AVAILABILITY
On what date will you be available for work?
Available for (check all that apply):	Full TimePart TimeShift WorkTemporary
If required, are you available to travel?	Yes No
If required, are you available for relocation?	Yes No

REFERENCES
Please provide references other than previous employers or relatives. Providing this information means that you give this organization permission to contact the references listed.
1. Name
Address
Phone

2. Name
Address
Phone

3. Name
Address
Phone

Store Manager

BECKLEY AREA MANAGER

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