St. Vincent de Paul Employment Application Personal Information Question Title * 1. St. Vincent de Paul Stores is an equal opportunity EmployerPersonal Information Name (First, Middle, Last) Address City State Zip Email address Phone Number Question Title * 2. Are you Eligible to work in the United States? Yes No Proof of eligiblity may be required before you can be employed. Question Title * 3. Are you at least 18 years of age? Yes No Question Title * 4. What date are you available for employment? Question Title * 5. Have you applied to St. Vincent de Paul before? Yes No Question Title * 6. Are you presently on lay off or absence from another employer? Yes No Question Title * 7. Do you have any agreements with another employer that would affect your employment here? Yes No Question Title * 8. Which position are you applying for? Please check all that apply. Assistant Manager Cashier Donation Attendant Furniture/ Warehouse Associate Clothing Hanger Floor Associate Truck Driver Question Title * 9. What type of employment are you seeking? (check all that apply) Full-Time Part-Time Seasonal Question Title * 10. St. Vincent de Paul operates seven thrift stores throughout the Cincinnati area. Please check each store location at which you would be interested in working: Colerain: 8269 Colerain Ave, 45239 Este Ave: 4530 Este Ave, 45232 *Truck teams routed from this location* Evendale: 9864 Reading Rd, 45241 Mason: 1065 Reading Rd, 45040 Milford: 813 Main St, 45150 Mt. Washington: 2300 Beechmont Ave, 45230 Western Hills: 3015 Glenhills Way, 45238 Question Title * 11. Please indicate the times you are available to work? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Question Title * 12. Please list any activities that may conflict with the information provided above: Question Title * 13. Which shift do you prefer? 1st 2nd Question Title * 14. Are you currently attending school? Yes No If yes, when do you expect your schedule to change again? Question Title * 15. Most Recent Employer Employer Name, Address, Phone # Date of Employment Full-Time, Part-Time, or Seasonal? Salary/Monthly Earnings ($) Name of Supervisor Nature of Work Reason for Leaving Question Title * 16. Second most recent employer Employer Name, Address, Phone # Date of Employment Full-Time, Part-Time, or Seasonal? Salary/Monthly Earnings ($) Name of Supervisor Nature of Work Reason for Leaving Question Title * 17. Third most recent employer Employer Name, Address, Phone # Date of Employment Full-Time, Part-Time, Seasonal? Salary/Monthly Earnings ($) Name of Supervisor Nature of Work Reason for Leaving Question Title * 18. What is your minimum salary requirement? Question Title * 19. What past work experience do you feel is most applicable to this position? Question Title * 20. As an applicant for employment, I understand the following: • This application will remain on active file for sixty (60) days. If I am hired within this period, this form will be transferred to my individual personnel file.• If I am not hired within sixty (60) days, this application is no longer active and I will need to reapply for employment if I wish to be considered for a position after that time.• Any misrepresentation or falsification of information or significant omissions will be cause for rejection of my application or for subsequent discipline up to and including my dismissal from employment if discovered at a later date.• After an offer of employment has been extended, I may be required to submit to a physical examination. This may include a drug screen, in order to determine my physical ability to perform my job duties with or without accommodation.• My employment may be contingent upon the result of this examination and drug screen. If the results of the physical examination indicate that I cannot perform the job for which an offer has been extended and/or if the drug screen results are positive for substance abuse, this will be grounds for disqualifying me or terminating my offer of employment.• If my application for employment is accepted, the effective date of employment shall be the time I actually begin to work. If I am employed, I agree to comply with and be bound to the safety and health rules and regulations, and the standards of conduct of my employer.• My employment is not guaranteed for any term, and my employment may be terminated by my employer or myself at any time and for any reason. No management official is authorized to make any oral assurance or promise of continued employment.• All information (including information on any accompanying resume) is subject to verification. ----------------------------------------------------------------------------------------------------------------------------------• I authorize you to contact and I authorize any present or former employer, education institution, law enforcement agency, financial institution, or other persons having personal knowledge about me to furnish any and all information in their possession regarding me, in connection with any decision concerning my employment. Further, I hereby release from liability and hold harmless all persons and corporations supplying this information. A photocopy of this authorization is as valid as the original.Do you agree with the above statement of application? Yes No Done