| Jelinek Hardware Company is an equal opportunities employer and fully subscribes to the principles of Equal Employment Opportunity. Equal access to programs, services and employment is available to all persons. Applicants requiring accommodation to the application and/or interview process should contact a representative of the Personnel Department. Applications will be considered active for 90 days. |
* What type of work are you interested in?
Management
Sales
Maintenance/Warehouse
Small Engine Technician
Cashier
Office/Clerical
Other, please specify
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Full Time
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| Personal |
* Last Name
* First Name
* Middle Name
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* Street Address
* City
* State
* Zip Code
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| * Phone Number
* Email Address
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Previous Address
City
State
Zip Code
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Reason for moving from previous address
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* Best time to reach you at home
May we contact you at work?
If Yes,
Work Number
Best time to reach you at work
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| Referral Source
Advertisement
Walk In
Employee
Online
Other
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* Have you been convicted of a felony in the last seven (7) years? (Such conviction may be relevant if job related, but does not bar you from employment.)
If yes, please explain
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| * Driver’s license number
* State
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| Education |
| * Highest year of High School completed
* Graduated
GED
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| College or Tech School
Graduated
Graduate School
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| High School
City
State
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| College/Technical
City
State
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| List any additional education
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| Are you attending school now?
If yes, list days and times you attend school
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Employment History - List current and previous employers below. Begin with the most recent employer. |
| #1 Current or Past Employer
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| Street Address
City
State
Zip Code
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| Supervisor
Work Number
May we contact this employer?
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| Date Started
Year
Leaving Date
Year
Status
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| Starting Pay Rate
Final Pay Rate
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| Describe Job Duties
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| Reason you left
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| Length of time of inactivity between this application date and Employer #1
years
months |
| Reason for inactivity between this application date and Employer #1
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| #2 Current or Past Employer
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| Street Address
City
State
Zip Code
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| Supervisor
Work Number
May we contact this employer?
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| Date Started
Year
Leaving Date
Year
Status
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| Starting Pay Rate
Final Pay Rate
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| Describe Job Duties
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| Reason you left
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| Length of time of inactivity between Employer #1 and Employer #2
years
months |
| Reason for inactivity between Employer #1 and Employer #2
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| #3 Current or Past Employer
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| Street Address
City
State
Zip Code
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| Supervisor
Work Number
May we contact this employer?
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| Date Started
Year
Leaving Date
Year
Status
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| Starting Pay Rate
Final Pay Rate
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| Describe Job Duties
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| Reason you left
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| Length of time of inactivity between Employer #2 and Employer #3
years
months |
| Reason for inactivity between Employer #2 and Employer #3
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| What hourly wage or salary do you expect?
per hour
per week |
| * List the times you will be available to work during our store hours: Sunday 9 am to 6 pm, and Monday through Saturday 7:30 am to 9 pm |
Sunday
to
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Monday
to
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Tuesday
to
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Wednesday
to
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Thursday
to
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Friday
to
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Saturday
to
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Skills and Qualifications
Summarize any specific work skills you have which may not be adequately covered in review of your work or educational
history. (Include special training, licenses, certificates and/or characteristics of yourself that may apply).
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References |
| List name and telephone number of three personal references who are not related to you and are not previous supervisors. |
* Name |
* Relationship |
* Phone Number |
* Years Known |
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It is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed.
I give the employer the right to investigate all references and to secure additional information about me, if job-related.
I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicantʼs consideration for employment on a basis prohibited by local, state or federal law.
I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.
I understand it is this companyʼs policy not to refuse to hire a qualified individual with a disability because of this personʼs need for an accommodation that would be required by the ADA.This application is current for only 90 days. At the conclusion of this time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to fill out a new application. |
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