Employment Application

All fields highlighted in yellow are required

Various Federal, State and Local laws prohibit discrimination based on race, color, sex, religion, national origin, ancestry, age, disability or marital status. Triplett, Inc. is an equal opportunity employer and your response to any question will not be used as a basis for discrimination, but will be judged on its relevance to the position you are seeking. This application is active for one month after application date.

Personal Information
Date

Name (Last)

First

Middle

Home Address

City

State

Zip

Primary Telephone

Secondary Telephone

Email Address

May we contact you at work?

Yes

No

Position(s) applying for:
(check all that apply)

Manager

Asst. Manager

Cashier

Office Staff

Maintenance

Bookkeeping

Wait Staff

Sales

CDL Driver

Cook

Dishwasher

Other

Salary Desired

$

per

Are you interested in (check all that apply)

Full Time

Part Time

Temporary

What Shift/hours do you prefer?

Date Available
(mm/dd/yyyy)

Can you work overtime, if required?

Yes

No

Weekends?

Yes

No

Which store are you applying to?

Are you willing to relocate?

Yes

No

Are you willing to travel?

Yes

No

Are you 18 years
of age or older?

Yes

No

How were you referred to Triplett, Inc.?

(if by current employee, please
indicate them by name)

How many days of work/school have you missed in the past year?

Please Explain:

 
Education

High School Name

Address

City

State

Degree / Area of Study

Years Attended

Graduated
(Check One)

Yes

No

College School Name

Address

City

State

Degree / Area of Study

Years Attended

Graduated
(Check One)

Yes

No

Other School Name

Address

City

State

Degree / Area of Study

Years Attended

Graduated
(Check One)

Yes

No

Military Service Information

Branch of Service

Technical Specialization

Rank Attained

Legal

Are you a U.S. citizen or do you have a legal right and necessary documents to work in the U.S.?
(Identity and employment eligibility of all new hires will be verified as required by the Immigration Reform and Control Act of 1986)

Yes

No

Have you ever been discharged by any company?

Yes

No

If yes, give name of company(ies)

Reason for discharge

Have you ever been convicted of a crime other than minor traffic violations? (Note: You are not obligated to discuss sealed or expunged records of conviction or arrest,
nor will such information be asked of you or considered in employment decisions.) The existence of a criminal record will not automatically disqualify you from the job for
which you are applying.

Yes

No

If yes, please explain offense and final disposition

Answer the following question ONLY if you are applying for a Retail Store Position

Have you been convicted within the two preceding years of a violation of liquor laws?

Yes

No

Employment History - List employment starting with your most recent position.

IMPORTANT: Check this box if you have never been employed

Dates:

Name and Address of Employer:

Position Held
and Supervisor:

List Major Duties:

Salary or
Wages:

Reason For
Leaving:

Check this box if this is your current employer.

From:

mo / year

To:

mo / year

Employer Name

Employer Address

City

State

Zip

Phone

Your Job Title

Supervisor

Starting

Ending

From:

mo / year

To:

mo / year

Employer Name

Employer Address

City

State

Zip

Phone

Your Job Title

Supervisor

Starting

Ending

From:

mo / year

To:

mo / year

Employer Name

Employer Address

City

State

Zip

Phone

Your Job Title

Supervisor

Starting

Ending

From:

mo / year

To:

mo / year

Employer Name

Employer Address

City

State

Zip

Phone

Your Job Title

Supervisor

Starting

Ending

Please explain any gaps in employment

May we contact the employers listed above?

Yes

No

If no, please list employers you wish us not to contact

Were you employed under a different name?

Yes

No

If yes, please indicate name and which employer(s)

References

Business References ONLY. Do not list relatives. (Please indicate if you were employed under a different name)

Name

Address

Phone No.

Title

Years Known

Please Read Carefully

Qualified applicants are considered without regard to race, color, religion, national origin, age, handicap or veteran status. I understand that this document is an application for employment, and does not constitute an agreement or contract for employment of any length of time. By accepting employment with Triplett, Inc. I understand that I have no expressed or implied contractual rights to continue employment with the company. I also understand that I am required to abide by all rules and regulations of Triplett, Inc., and all pertinent laws. I also understand that I have the right to terminate my employment at any time with or without reason and with or without notice. My employment with Triplett, Inc. is commonly referred to as Employment-at-Will.

I certify that answers given herein are true and complete to the best of my knowledge. I understand that with my authorization by signing below, an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, educational background, credit record, criminal record and /or motor vehicle record, subject to applicable federal, state and local laws. I authorize investigation of all statements in this application for employment as may be necessary in arriving at employment decisions. Triplett, Inc. has the right to contact, including but not limited to, previous employers, schools and other references to verify this information. I release from liability; including but not limited to, companies, individuals, parties and/or institutions supplying this information. In the event of employment, I understand that false, omissions or misleading information given in my application or interview or any required document may result in denial of employment or discharge, whenever discovered. After termination of my employment for whatever reason, I release Triplett, Inc. from liability for any information supplied to future potential employers.

Applicant's Signature

The entry of your name in the Applicant's Signature box binds you, the applicant, to the terms and conditions stated within this Employment Application.