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(may be relevant if job related, but does not bar you from employment)


Availability


Employment History

Employment History: List your last employer, assignments or volunteer activities, including military experience.


Education

List name and location of school, any specific course of study, and year of graduation.

List name and location of school, any specific course of study, and year of graduation.

List name and location of school, any specific course of study, and year of graduation.


Personal References

Include full name, telephone, years known, and how acquainted.

Include full name, telephone, years known, and how acquainted

Include full name, telephone, years known, and how acquainted


Skills

Please list any skills, training, achievements, hobbies, sports in 25 words or less.


Agreement - Please read carefully before submitting

As an applicant I understand that any misrepresentation by me in the application will be sufficient cause for cancellation of any consideration for employment and/or separation from employment. I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations, and organizations for furnishing such information.

Nokomis Shoe Shop is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion or national origin. No question on this application is used for the purposes of limiting or excusing an applicant's consideration for employment on a basis prohibited by local, state or federal law. I have read, understand and agree to all the above terms and conditions.