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    BANNED SKATE SHOP, REDLANDS, CALIFORNIA

    Application for Employment

    If you do not feel you will pass a drug test, please do not bother to apply

    Personal Information:

    Name_____________________________________________________

    Social Security #___________________________CA I.D #______________

    Present Address____________________________City________________Zip________

    Phone( _ _ _ ) _ _ _-_ _ _ _        Are you 18 years or older ? YES     NO D.O.B.___________________________

    Employment Desired/ Position___________________

    Date you can start _____________________________ Full time_____ Part time_____ Are you employed now? YES_____ NO_____            

    May we inquire of your present employer? YES____ NO___                           Supervisor’s Name____________________________Phone ( _ _ _ ) _ _ _ - _ _ _ _ Education:

    High School ________________________ # of years_______ Did you Graduate?______

    College____________________________ # of years _______ Did you Graduate?______

    Trade School, etc.___________________ # of years _______ Did you Graduate?______

    Personal References:

    (Please list 3 non-relatives whom you have known for at least 2 years).

    NAME, PHONE RELATIONSHIP YEARS KNOWN (In case of Emergency):

    Address of nearest relative: Name/Address_____________________________________

    Phone ( _ _ _ ) _ _ _ - _ _  Cell ( _ _ _ ) _ _ _ - _ _ _ _

    Previous Employment:

    Please list the past 2 employments:(Most recent first)

    Company name/Address_______________________________ Phone_________________________________________ Date Start______________________________Date End___________________

    Last Position______________________ Pay rate/Start___________Pay rate/End__________ Reason for Leaving______________________________________

    Supervisor’s Name________________________________ Phone ( _ _ _ ) _ _ _ - _ _ _ _ Cell. ( _ _ _ ) _ _ _ - _ _ _ _

    Duties Required to Perform__________________________________________________

    ________________________________________________________________________

    Company name/Address______________________________Phone_______________ Date Start_______________ Date End_____________ Last Position________________

    Pay rate/Start_________Pay rate/End_________________

    Reason for Leaving_________________________________

    Supervisor’s Name______________Phone ( _ _ _ ) _ _ _ - _ _ _ Cell ( _ _ _ ) _  _ - _ _ _

    Duties Required to Perform_________________________________________________________________________________________________________________________________________What days or evenings are you available to work?(below) _____________________________________________________________________

    What hours are you available to work? (enter below) Are there any activities that would prevent you from working certain days and or hours?

    (enter below)

    Monday Tuesday Wednesday Thursday Friday  Sunday AM PM

    You will be Asked to work Weekends

    You will be Asked to work Weekends

    Why do you feel you would be a good employee at Banned?_________________________________________________

    What do you consider to be your outstanding qualities?____________________________________________________

    What do you consider to be your worst qualities?__________________________________________________________

    What kind of circumstances makes you nervous or tense? __________________________________________________

    Will it affect your work behavior?_______________________________________________________________________ Would you take a DRUG TEST ?_________

    Would you take a Polygraph(Lie detector) Test?_______

    Have you ever been convicted of a felony or misdemeanor? YES_______ NO_______ (if YES, explain)____________________________________________________________________________________ List your favorite hobbies/interest: 1.___________________ 2.____________________ 3._________________________ List any special skills:________________________________________________________________________________

    Applicant represents that all information given on this application is true and correct. Applicant hereby authorizes verification of all references and facts, including but not limited to current and previous employers, and personal references. Applicant hereby authorizes owner/agent/manager to obtain, Credit Reports, and/or criminal background reports. Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing which may result in denial of employment. Applicant hereby waives any claim and releases from liability any person providing or obtaining said verification or additional information. I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements of this application shall be grounds for dismissal. _______________________________ ________________________________

    Applicant Signature If minor, parent of guardian Thank you, we appreciate your patronage - please deliver it in person along with a resume