J&R Schugel Office & Shop Application Today's Date:* MM slash DD slash YYYY Position Applied For:* Name:* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone / Cell Phone:*Email Address:* AVAILABILITYAre you legally authorized to work in the United States?* Yes No Are you 18 years of age or older* Yes No On what date can you start?* MM slash DD slash YYYY What job category would you prefer?*Full-timePart-timeTemporaryOn Call/CasualFor what schedules would you be available?* Select All Weekdays Weekends Days Evenings Overtime All Shifts Other If other, please explain: EDUCATIONHighest grade completed:*7891011121314151616+HIGH SCHOOL NAME CITY/STATE DEGREE EARNED COLLEGE NAME CITY/STATE DEGREE EARNED OTHER CITY/STATE DEGREE EARNED JOB-RELATED SKILLSIf the job requires you to drive, do you have the appropriate valid driver's license?* Yes No DL# Type State of Issue Please list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or our organization. EMPLOYMENT HISTORYYour application may not be considered unless every question is answered. Since we may contact previous employers, correct telephone numbers are essential.MOST RECENT EMPLOYER Company Name* City* State* Phone*Dates Employed* (month/yr) To (month/yr)Supervisor's Name/Number* Job Title* Duties* Reasons for Leaving* SECOND MOST RECENT EMPLOYER Company Name* City* State* Phone*Dates Employed* (month/yr) To (month/yr)Supervisor's Name/Number* Job Title* Duties* Reasons for Leaving* THIRD MOST RECENT EMPLOYER Company Name* City* State* Phone*Dates Employed* (month/yr) To (month/yr)Supervisor's Name/Number* Job Title* Duties* Reasons for Leaving* REFERENCESInclude only individuals familiar with your work capabilities. Do not include relatives.NAME* ADDRESS/PHONE* YEARS KNOWN/RELATIONSHIP* NAME* ADDRESS/PHONE* YEARS KNOWN/RELATIONSHIP* NAME* ADDRESS/PHONE* YEARS KNOWN/RELATIONSHIP* AUTHORIZATION* I understand that background, drug, or medical testing may be conducted on me as part of the process to determine my fitness for employment, and hereby agree to submit to such testing. I authorize all persons, schools, companies, medical practitioners, current and/or former employers, and law enforcement authorities to release any information concerning my background or test results, and hereby release any said persons, schools, companies, medical practitioners, current and/or former employers, and law enforcement authorities from any liability for any damage whatsoever for issuing this information.CERTIFICATION* I certify the answers given by me to the foregoing questions and any statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts regarding information called for in this application may result in rejection of my application, or discharge at any time during my employment. I also agree that, if company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that if I am hired, my employment shall be “at-will,” and that either the Company or I can choose to terminate the employment relationship for any reason, or no reason at all, with or without notice.Name - By typing your name below you acknowledge that an electronic signature is equivalent to an ink signature.* First Last Date* MM slash DD slash YYYY CAPTCHA 36836