Employment Application Name(Required) First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail(Required) Position Applying For If you are under 18, can you furnish a work permit?(Required) Yes No Not Applicable Are you legally eligible for employment in this country?(Required) Yes No Have you been convicted of a felony within (7) years?(Required)(may be relevant if job related, but does not bar you from employment) Yes No If yes, please explainAvailabilityDaytime Sunday Monday Tuesday Wednesday Thursday Friday Saturday Select AllEvening Sunday Monday Tuesday Wednesday Thursday Friday Saturday Select AllEmployment HistoryList your last employer, assignments or volunteer activities, including military experience.Employer Supervisor and Title Employer PhoneEmployer Location City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Start Date MM slash DD slash YYYY End Date(leave blank if still employed there) MM slash DD slash YYYY Starting Wage(dollars per hour)Ending Wage(dollars per hour)Duties Reason for LeavingEducationList name and location of school, any specific course of study, and year of graduation.High School College Other School Personal ReferencesInclude full name, telephone, years known, and how acquainted.Reference 1 Reference 2 Reference 3 SkillsSkillsPlease list any skills, training, achievements, hobbies, sports in 25 words or less.Agreement — Please Read Carefully Before Submitting(Required)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. I agree to the terms below.Upload Résumé(optional)Accepted file types: pdf, docx, rtf, txt, Max. file size: 50 MB.NameThis field is for validation purposes and should be left unchanged. Δ