Fillable Printable Target World Employment Application Form

Target World Employment Application Form

Instructions: Print clearly in black or blue ink. Answer all questions. Sign and date the form. Either bring the form in to

Target World or mail it to us at:

Target World

2300 East Kemper Road

Cincinnati, OH 45244

APPLICANT INFORMATION:

Applicant Name ______________________ _________________

Home Phone _________________________________________

Other _______________________________________________

Email Address ___ _____________________ ________________

Current Address:

Number and street ________________________________ ____

City ________________________________________ ________

State & Zip ______________________________________ ____

Social Security #______________________ ________________

How were you referred to Target World?:_____________ _______________________________ ___________

POSITION/AVAILABILITY:

Position(s) applying for:_ ____________ _______________________________ _

Are you applying for:

• Regular part-time work? [ ] Y or [ ] N

• Regular full-time work? [ ] Y or [ ] N

What days and hours are you available for work?_______________________ ____________________________

If applying for temporary work, when will you be available? _____________________________________ ______

If hired, on what date can you start working? ___ / ___ / ___

Can you work on the weekends? [ ] Y or [ ] N

Can you work evenings? [ ] Y or [ ] N

Are there any hours, shifts or days you cannot or will not work? ____ ____________________________________

Are you available to work overtime? [ ] Y or [ ] N

Salary desired: $_____________ ___________________

Page 1 of 5

PERSONAL INFORMATION:

Have you ever applied to / worked for Company before? [ ] Y or [ ] N

If yes, please explain (include date): ___ _____________________ ________________

Do you have an y friends, rela tives, or acquaintances working for Compan y? [ ] Y or [ ] N

If yes, state name & relationship: ___________________________________ ________

If hired, would you have transportation to/from work? [ ] Y or [ ] N

If hired, are you willin g to submit to and pass a controlled substance test? [ ] Y or [ ] N

Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable

accommodation? [ ] Y or [ ] N

If no, describe the functions that cannot be performed:

___________________________________

________________________________________________________________________

(Note: Company comp lies with the ADA and consider reasonable accommodation measures that may be necessary

for eligible applicants/employees to perform essential functions. It is possible that a hire may be tested on skill/agility

and may be subject to a medical examination cond ucted by a medical prof essional.)

Have you ever been convicted of a criminal offense (felony or misdemeanor)? [ ] Y or [ ] N

If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the

case.________________________________________________ _______________________________ ____

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of

the offense, the nature of the offense, includ ing any significant details that affect the desc ription of the event, and the

surrounding cir cumstances and the relevance of the offense to the position(s) app lied for may, however, be

considered.)

EDUCATION:

High School:

School name: ____________ __________________________

School city, state:______________________ _____________

Number of years completed: _______________

Did you graduate? [ ] Y or [ ] N

Degree / diploma earned: _________________

College / University #1:

School name: ____________ __________________________

School city, state:______________________ _____________

Number of years completed: _______________

Did you graduate? [ ] Y or [ ] N

Degree / diploma earned: _________________

College / University #2:

School name: ____________ __________________________

School city, state:______________________ _____________

Page 2 of 5

Number of years completed: _______________

Did you graduate? [ ] Y or [ ] N

Degree / diploma earned: _________________

Vocational School:

School name: ____________ __________________________

School city, state:______________________ _____________

Number of years completed: _______________

Did you graduate? [ ] Y or [ ] N

Degree / diploma earned: _________________

SPECIAL SKILLS AND QUALIFICATIONS: List job-related licenses, skills, training, honors, awards, and special

accomplishments.

_____________________________________________________________

EMPLOYMENT HISTORY:

Are you currently employed? [ ] Y or [ ] N

If you are currently employed, may we contact your current employer? [ ] Y or [ ] N

Below, please describe past and present employment positions, datin g back five years. Please account for all periods

of unemployment. E ven if you have attached a resume, this section mu st b e completed.

Name of Employer:____ _____________________ _____________

Name of Supervisor:______________________ ______________

Telephone Number:______________________________________

Business Type:[ ________________________

Address:________________________

City, state, zip:____________ ____________________

Length of Employment (Include Dates): _____________________

Position & Duties:___________________________________________ ____________

Reason for Leaving: ___________ _______________________________ ___________________

May we contact this employer for references? [ ] Y or [ ] N

Name of Employer:____ _____________________ _____________

Name of Supervisor:______________________ ______________

Telephone Number:______________________________________

Business Type: ___________ _____________

Address:________________________

City, state, zip:____________ ____________________

Page 3 of 5

Length of Employment (Include Dates): _____________________

Position & Duties:___________________________________________ ____________

Reason for Leaving: ___________ _______________________________ ___________________

May we contact this employer for references? [ ] Y or [ ] N

Name of Employer:____ _____________________ _____________

Name of Supervisor:______________________ ______________

Telephone Number:______________________________________

Business Type: ___________ _____________

Address:________________________

City, state, zip:____________ ____________________

Length of Employment (Include Dates): _____________________

Position & Duties:___________________________________________ ____________

Reason for Leaving: ___________ _______________________________ ___________________

May we contact this employer for references? [ ] Y or [ ] N

Military:

Branch: _____________________________________

Rank At Discharge:_______________________________

Total Years of Service: ________

Skills/duties: _____________________________________________ ______________________________

Related details:_________ ______________________ __________________________________________

REFERENCES:

List below three persons who have knowledge of your work performance within the last four years.

Please includ e professional references only.

Name - First, Last: ____________________________ __________

Telephone Number:_____________________________________

Address:______________________________________________

City, state, zip:____________ ______________________________

Occupation: ____________________________________________

Number of Years Acquai nted: ______________________________

Name - First, Last: ____________________________ __________

Telephone Number:_____________________________________

Address:______________________________________________

City, state, zip:____________ ______________________________

Occupation: ____________________________________________

Number of Years Acquai nted: ______________________________

Name - First, Last: ____________________________ __________

Telephone Number:_____________________________________

Address:______________________________________________

City, state, zip:____________ ______________________________

Page 4 of 5

Occupation: ____________________________________________

Number of Years Acquai nted: ______________________________

Please Read and Initial Each Paragr aph, then Sign Below

I certify that I have not purposely withheld any information that might adversel y affect m y chances for hiring. I attest to

the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that

any omission (i ncluding any m isstatement) of material fact on this application or on any document used to secure can

be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from

the company.

_____

I understand that if I am employed, my employment is not definite and can be terminated at any time either with or

without prior notice, and by either me or the compan y.

_____

I permit the company to examine my references, record of employment, education record, and any other information I

have provided. I authorize the references I have listed to disclose any information related to my work record and my

professional experiences with them, without giving me prior notice of suc h disclosure. In addition, I release the

company, my former employers & all other persons, corpor ations, partnerships & associations from any & all claims,

demands or liabilities arising out of or in any way related to such examination or revelation.

_____

Applicant's Signature:___ __________ _________________

Date:_________________________________

Page 5 of 5