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POTENTIAL EMPLOYEE INFORMATION FORM
Date
01
02
03
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05
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Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
Time
a.m
p.m
Name and Address
First Name
Last Name
Address
City
State
-select state-
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Zipcode
Phone (
)--
Email
Skills and Experiences:
Do you have experience?
Yes
No
Can you read a planogram?
Yes
No
Where have you worked as a retail merchandiser
Rate and Working Hours
Were you an hourly employee?
Yes
No
How much were you paid an hour? $
What is your desired starting hourly rate?
$
Do you desire to work
Full time
Yes
No
Part time
Yes
No
Will you accept work on an on-call basis?
Yes
No
What is your availability
Anytime
7a.m-6p.m
9a.m-2p.m
12Noon-6p.m
Referred by
How did you hear about us
Friend
Ad
Internet
Current Employee
Referred Friend's Name
Referred Newspaper Name
Referred Site Name
Name of Current Employer
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