Employment Application Name(Required) First Last Date(Required) MM slash DD slash YYYY Address(Required) 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 Phone(Required)Email(Required) Position applying for(Required) Date you can start(Required) MM slash DD slash YYYY List of hobbies, interests or other involvements(Required)Currently Employed(Required) Yes No Preferred Status(Required) Full Time Part Time High School Name(Required) Did you graduate(Required) Yes No College Name Years AttendedList any achievements you have earned (I.E. employment, education, personal, sports)(Required)Please indicate the days and times you are able to work. Please note that you are not asked to work all hours you are available. This information helps us to match you with opportunities based on your availability.Sunday(Required) Available Not Available Sunday Start(Required) Hours : Minutes AM PM AM/PM Sunday End(Required) Hours : Minutes AM PM AM/PM Monday(Required) Available Not Available Monday Start(Required) Hours : Minutes AM PM AM/PM Monday End(Required) Hours : Minutes AM PM AM/PM Tuesday(Required) Available Not Available Tuesday Start(Required) Hours : Minutes AM PM AM/PM Tuesday End(Required) Hours : Minutes AM PM AM/PM Wednesday(Required) Available Not Available Wednesday Start(Required) Hours : Minutes AM PM AM/PM Wednesday End(Required) Hours : Minutes AM PM AM/PM Thursday(Required) Available Not Available Thursday Start(Required) Hours : Minutes AM PM AM/PM Thursday End(Required) Hours : Minutes AM PM AM/PM Friday(Required) Available Not Available Friday Start(Required) Hours : Minutes AM PM AM/PM Friday End(Required) Hours : Minutes AM PM AM/PM Saturday(Required) Available Not Available Saturday Start(Required) Hours : Minutes AM PM AM/PM Saturday End(Required) Hours : Minutes AM PM AM/PM Please indicate the number of hours you are willing to work in a 7 day period(Required)Washpointe has several locations. Are you able to work multiple locations?(Required) Yes No Do you have your own transportation?(Required) Yes No Former employment history, if APPLICABLE:Employer Name Position Dates Employed Reason for leaving Employer Name Position Dates Employed Reason for leaving Employer Name Position Dates Employed Reason for leaving Employer Name Position Dates Employed Reason for leaving Answer the following questions:What do you perceive as good customer service?(Required)What qualities do you have that make you a good candidate for this job?(Required)What does teamwork mean to you?(Required)Where do you see yourself in five years?(Required)Please list two employment references who we can contact—can include family or school.Name(Required) First Last Company(Required) Phone(Required)Name(Required) First Last Company(Required) Phone(Required)Do you have a pre-existing illness or injury that may impact your ability to safely perform the requirements of the position applied for?(Required) Yes No Resume (If Applicable)Max. file size: 512 MB.Consent(Required) I certify that the facts contained in this application are true and complete to the best of my knowledgeI certify that the facts contained in this application are true and complete to the best of my knowledge and understand that falsified statement are grounds for dismissal. I understand and agree that, if hired, my employment may be terminated at any time without prior notice. I authorized the investigation of all information contained herein and release all parties from all liability for any damages resulting from furnishing same.
