12TH & BROADWAY
(502) 583-5145
1133 W. BROADWAY
LOUISVILLE, KY 40203
STORE HOURS
MONDAY-FRIDAY
9 AM - 6 PM
SATURDAY
10 AM - 5 PM
Application For Employment
PRE-EMPLOYMENT QUESTIONNAIRE EQUAL OPPORTUNITY EMPLOYER
Personal Information / Date
Employment Desired
ARE YOU EMPLOYED NOW?YESNO
IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?YESNO
EVER APPLIED TO THIS COMPANY BEFORE? YESNO
Education History
NAME & LOCATION OF SCHOOL
YEARS ATTENDED
DID YOU GRADUATE
SUBJECTS STUDIED
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL
General Information
Former Employers (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)
DATE MONTH AND YEAR
NAME & ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
FROM TO
Additional Notes
Δ
Name Address Phone Number Referred By Position Date You Can Start