Employment Application If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. First Name * Last Name * Address City, State, Zipcode Position Applying For Phone Email If you are a human and are seeing this field, please leave it blank. If you are under 18, can you furnish a work permit? YesNoNot applicatble Are you legally eligible for employment in this country? YesNo Have you been convicted of a felony within (7) years? (may be relevant if job related, but does not bar you from employment) YesNo If yes, please explain: Availability Daytime MondayTuesdayWednesdayThursdayFridaySaturdaySunday Evening MondayTuesdayWednesdayThursdayFridaySaturdaySunday Employment History Employment History: List your last employer, assignments or volunteer activities, including military experience. Employer Supervisor and Title Telephone City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Start Date End Date (leave blank if still employed there) Starting Wage (dollars per hour) Ending Wage (dollars per hour) Duties Reason for Leaving Education High School List name and location of school, any specific course of study, and year of graduation. College List name and location of school, any specific course of study, and year of graduation. Other School List name and location of school, any specific course of study, and year of graduation. Personal References Reference 1 Include full name, telephone, years known, and how acquainted. Reference 2 Include full name, telephone, years known, and how acquainted Reference 3 Include full name, telephone, years known, and how acquainted Skills 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. Upload Resume (Optional)