Battery Joe

Employment Application

First Name

Last Name

Cell Phone Number

Home Phone Number

Email

Street Address

Address Line 2

City

State/Province/Region

Driver's License Number

Company #1 Name

Company #1 Phone Number

City & State

Zip Code

Start Date of Employment

End Date of Employment

Position Title

Supervisor Name

Reason for Leaving

Company #2 Name

Company #2 Phone Number

City & State

Zip Code

Start Date of Employment

End Date of Employment

Position Title

Supervisor Name

Reason for Leaving

Company #3 Name

Company #3 Phone Number

City & State

Zip Code

Start Date of Employment

End Date of Employment

Position Title

Supervisor Name

Reason for Leaving

Do you have a background with customer service?

Yes No

Are you physically able to lift up to 50 pounds at a time?

Yes No

Do you have basic knowledge of computers?

Yes No

Would you be willing to install automotive batteries when needed?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, please explain:

Would you have any objections to a drug test and background check?

Yes No

Do you have any disabilities that may prevent you from performing at this job?

Yes No

Do you have a reliable means of transportation getting to and from work?

Yes No

Would you be willing to work Saturdays?

Yes No

How many hours per week are you willing to work?

What date can you start?

Desired Salary (Per Hour)

Would you ever be willing to transfer locations within town?

Are you legally authorized to work in the United States?

Yes No

Will you now or in the future require sponsorship?

Yes No