Employment Form

APPLICATION FOR EMPLOYMENT

**Please be advised that most of our positions consist of interaction with the public that may require long periods of standing and accessing stairs and aisles.

(Pre-Employment Questionnaire)

(An Equal Opportunity Employer)

    Date:

    Last Name:

    Home Address:

    City, State, Zip Code:

    Soc. Sec. No:

    First Name:

    Phone Number:

    Cell Number:

    Email Address:

    What kind of work are you applying for?

    What special qualifications do you have?

    What office machines can you operate?

    Are you 18 years or older: YesNo

    Date of Birth?

    Do you have reliable transportation: YesNo

    Are you a United States Citizen? YesNo

    If not, are you authorized to work in the U.S.? YesNo

    Height:
    (Uniform Purposes Only)

    Weight:
    (Uniform Purposes Only)

    Have you been convicted of a felony or misdemeanor within the last 7 years? YesNo

    If yes, please describe?

    Military Service Record

    Branch of Service:

    Discharge Date:

    Rank:

    Present membership in National Guard or Reservers:

    Date obligation ends:

    Education

    Name of High School:

    Address:

    City, State, Zip:

    Did you Graduate:

    Name of College:

    Address:

    City, State, Zip:

    Did you Graduate:

    Other Education Acquired:

    Address:

    City, State, Zip:

    Did you complete Course or Graduate:

    Employment History

    May we contact you current employer: YesNo

    Name of Company:

    Address:

    City, State, Zip:

    Phone Number

    Reason For Leaving

    Name of Company:

    Address:

    City, State, Zip:

    Phone Number

    Reason For Leaving

    Name of Company:

    Address:

    City, State, Zip:

    Phone Number

    Reason For Leaving

    Personal References

    Name:

    Address:

    City, State, Zip:

    Phone:

    Name:

    Address:

    City, State, Zip:

    Phone:

    Name:

    Address:

    City, State, Zip:

    Phone:

    NPB Application Employment Pre-Screen

    1. Do you have a High School Diploma or GED? (If the answer is NO, do not proceed)

      YesNo

    2. Do you have a good work history?

      YesNo

    3. Can you work in extreme heat in the summer and extreme cold in winter?

      YesNo

    4. Can you pass a criminal background check? (If NO please explain)

      YesNo

    5. Do you have reliable transportation?

      YesNo

    6. Do you have knowledge of principles and procedures for providing good customer and personal services? This includes customer needs, assessment and quality customer service.

      YesNo

    7. Do you have face to face customer service experience?

      YesNo

    8. Do you have professional dress and image?

      YesNo

    9. Are you able to work a flexible shift such as days, evenings, overnights including weekends and holidays?

      YesNo

    10. Are you physically able to stand for long periods?

    11. 0-5 hoursYesNo5-10 hoursYesNo10-15 hoursYesNo