Ad Number or Desired Location

SECTION I

First Name       Middle Initial     Last Name  

Street Address    Street Address 2

City   State          Zip Code   

Length At Current Residence            Years            Months

Telephone Number   Cellular Phone Number

Retail    Restaurant    Hotel    Other

How many hours per week can you work? 10 15 20 25 30 30+ Nights Yes No Weekends Yes No

Management Full-Time Associate Part-Time Associate Seasonal Associate

Have you ever been employed by Infoplace USA before? No Yes

Can you upon employment, submit verification of your legal right to work in the United States? Yes No

Background Information (We perform drug and background investigations for all employees)

Have you ever been convicted of any criminal offense (felonies and or misdemeanors) other than a minor traffic citation? No Yes

If yes, please explain

Education

High School:

Name         Street Address    

City           State        Zip Code    

Years Completed 4 3 2 1   Graduated Yes No

College:

Name       Street Address   

City         State        Zip Code  

Years Completed 1 2 3 4   Graduated No Yes

Employment History (Must list employment for the past 5 years) We conduct reference checks.

1. Present or Last Employer Name     Contact Name  

Telephone Number   Position Held  

Wage $ How Long 0 1 2 3 4 5 6 7 8 9 10+ Years 0 1 2 3 4 5 6 7 8 9 10 11 12 Months

Reason For Leaving

2. Previous Employer Name          Contact Name  

   Telephone Number Position Held

   Wage $ How Long 0 1 2 3 4 5 6 7 8 9 10+ Years 0 1 2 3 4 5 6 7 8 9 10 11 12 Months

   Reason For Leaving

    

3. Previous Employer Name         Contact Name   

   Telephone Number Position Held

   Wage $ How Long 0 1 2 3 4 5 6 7 8 9 10+ Years 0 1 2 3 4 5 6 7 8 9 10 11 12 Months

   Reason For Leaving

Previous Residence

2. Street Address   Street Address 2

   City    State        Zip Code   

   Length At This Residence            Years            Months

    

3. Street Address   Street Address 2

   City     State      Zip Code  

   Length At This Residence            Years            Months

    

4. Street Address   Street Address 2

   City     State       Zip Code   

   Length At This Residence            Years            Months

    

5. Street Address   Street Address 2

   City      State       Zip Code   

   Length At This Residence            Years            Months

Section II

If you have a resume' already created, copy and paste it into the space below. 

NOTE:  Some of the information contained within Section I may be required prior to submitting your application.

Thank you for applying with Infoplace USA ®.  Once your qualifications are reviewed and if those qualifications match our current requirements, you may be contacted by a hiring supervisor. 

Please note, the information provided above will be utilized as prescreening information.  If it is found that our criteria meet your qualifications, you will be required to complete a manual application.