Employment

Education

High School

Name

Address

City

State

Zip

Degree/Area of Study

Number of Years Attended

Graduated (Check One)

Yes

College

Name

Address

City

State

Zip

Degree/Area of Study

Number of Years Attended

Graduated (Check One)

Yes

Graduate School

Name

Address

City

State

Zip

Degree/Area of Study

Number of Years Attended

Graduated (Check One)

Yes

Other

Name

Address

City

State

Zip

Degree/Area of Study

Number of Years Attended

Graduated (Check One)

Yes

U.S. Military Service

Branch of Service

Technical Specialization

Rank Attained

Special Skills

Typing Speed / Shorthand or Speedwriting / CRT

WPM

Strokes/Hour

PC Software/Other Equipment

Legal

Are you a U.S. citizen or do you have a legal right & necessary documents to work in the U.S. I-9? (Identity and employment eligibility of all new hires will be verified as required by the Immigration and Control Act of 1986.)

Yes

Were you ever discharged by an employer?

Yes

If yes, give name of company (ies)

Reason for discharge

Have you ever been convicted of a crime other than a minor traffic violation? The existence of a criminal record will not automatically disqualify you from the job for which you are applying.

Yes

If yes, please explain offense and final disposition:

Employment History

List employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature of your activities.

May we contact your present employer?

Yes

Past employer?

Yes

Please indicate if you were employed under a different name.

From

Name of Employer

Address

City

State

Phone

Your Job Title

Supervisor

Starting Salary or Wages

Final Salary or Wages

List Major Duties

Reason for Leaving

From

Name of Employer

Address

City

State

Phone

Your Job Title

Supervisor

Starting Salary or Wages

Final Salary or Wages

List Major Duties

Reason for Leaving

From

Name of Employer

Address

City

State

Phone

Your Job Title

Supervisor

Starting Salary or Wages

Final Salary or Wages

List Major Duties

Reason for Leaving

From

Name of Employer

Address

City

State

Phone

Your Job Title

Supervisor

Starting Salary or Wages

Final Salary or Wages

List Major Duties

Reason for Leaving

Have you previously worked for Rosie's on Mars?

Yes

Name

Location

City & State

Position Held

Supervisor

Dates Employed

From

Reason for Leaving

References

Business references:
(do not list relatives) (please indicate if you were employed under a different name)

Name

Address

Work Phone #

Title

Years Known

Name

Address

Work Phone #

Title

Years Known

Name

Address

Work Phone #

Title

Years Known

Please Read Carefully

I understand that, with my authorization, an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, educational background, credit record and/or criminal history.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in immediate dismissal. I understand, also, that I am required to abide by all rules and regulations of Rosie's on Mars™.

I understand and agree that if employed, the employment will be "at will". That is, either I or Rosie's on Mars™ may end the employment relationship at any time, for any reason, or for no reason. Receipt of this application by Rosie's on Mars™ does not imply employment and that this application and/or any other Rosie's on Mars™ documents are not contracts of employment.

APPLICANT'S SIGNATURE

DATE SIGNED

Employment

Employment

Personal Information

Education

High School

College

Graduate School

Other

U.S. Military Service

Special Skills

Legal

Employment History

References

Please Read Carefully