Application for Employment

Name Date

Last First Middle

Address

Street City State Zip Code

Telephone # ( ) Other Phone # ( )

Social Security # Referred by

Position(s) applied for Date available

Type of employment desired Full-Time Part-Time Temporary Seasonal Educational Co-Op

Salary desired If currently employed, may we contact your employer? Yes No

Are you legally eligible for employment in this country? Yes No

If you are under 18 and it is required, can you furnish a work permit? Yes No

Are you available to work overtime if required? Yes No

Have you applied with MBE/The UPS Store before? Yes No

Have you been employed at MBE/The UPS Store before? Yes No

If yes, when? and at what location?

Do you have any friends or family employed at this location? Yes No

Have you been convicted of a crime in the last seven (7) years? Yes No

If yes, please explain

CONVICTION WILL NOT NECESSARILY BE A DISQUALIFICATION FOR EMPLOYMENT.

EDUCATIONAL BACKGROUND

List previous three (3) educational institutions attended, beginning with the most recent.

			DEGREE(s)/DIPLOMA(s)
SCHOOL	CITY, STATE	GRADUATED?	EARNED
		Yes No
		Yes No
		Yes No

EMPLOYMENT BACKGROUND

Provide the following information beginning with the most recent employer.

EMPLOYER	TELEPHONE	DATES EMPLOYED		SUMMARIZE THE TYPE OF WORK
	( )	FROM	TO	PERFORMED AND JOB RESPONSIBILITIES
ADDRESS
JOB TITLE		HOURLY RATE/SALARY
		STARTING
IMMEDIATE SUPERVISOR AND TITLE		$	per
REASON FOR LEAVING		HOURLY RATE/SALARY
		FINAL
MAY WE CONTACT FOR REFERENCE?		$	per
Yes No Later
EMPLOYER	TELEPHONE	DATES EMPLOYED		SUMMARIZE THE TYPE OF WORK
	( )	FROM	TO	PERFORMED AND JOB RESPONSIBILITIES
ADDRESS
JOB TITLE		HOURLY RATE/SALARY
		STARTING
IMMEDIATE SUPERVISOR AND TITLE		$	per
REASON FOR LEAVING		HOURLY RATE/SALARY
		FINAL
MAY WE CONTACT FOR REFERENCE?		$	per
Yes No Later
EMPLOYER	TELEPHONE	DATES EMPLOYED		SUMMARIZE THE TYPE OF WORK
	( )	FROM	TO	PERFORMED AND JOB RESPONSIBILITIES
ADDRESS
JOB TITLE		HOURLY RATE/SALARY
		STARTING
IMMEDIATE SUPERVISOR AND TITLE		$	per
REASON FOR LEAVING		HOURLY RATE/SALARY
		FINAL
MAY WE CONTACT FOR REFERENCE?		$	per
Yes No Later
EMPLOYER	TELEPHONE	DATES EMPLOYED		SUMMARIZE THE TYPE OF WORK
	( )	FROM	TO	PERFORMED AND JOB RESPONSIBILITIES
ADDRESS
JOB TITLE		HOURLY RATE/SALARY
		STARTING
IMMEDIATE SUPERVISOR AND TITLE		$	per
REASON FOR LEAVING		HOURLY RATE/SALARY
		FINAL
MAY WE CONTACT FOR REFERENCE?		$	per
Yes No Later

COMMENTS INCLUDING EXPLANATION OF ANY GAPS IN EMPLOYMENT:

REFERENCES

List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please).

		YEARS	PHONE
NAME	RELATIONSHIP	ACQUAINTED	NUMBER
			( )
			( )