Application

Store Location
Name:
Address:
E-mail:
Phone:
-
Date Available
Desired Salary $/hr
Position Applied for
Started Vaping Date
Vape Equipment
Are you a citizen of the United States?
If not a citizen are you authorized to work in the U.S.?
Do you understand this is a drug free workplace?
Have you ever been convicted of a felony?
If Yes, explain
High School
Address
from
to
Did you graduate High School?
College
College Address
College from
College to
Did you graduate college?
Professional Reference Name #1
Professional Reference Relationship #1
Professional Reference Phone #1
Professional Reference Company #1
Professional Reference Address #1
Professional Reference Name #2
Professional Reference Relationship #2
Professional Reference Phone #2
Professional Reference Company #2
Professional Reference Address #2

Previous Employment

Company #1
Phone #1
Address #1
Supervisor #1
Job Title #1
Starting Salary / Ending Salary #1
Responsibilities #1
From/To #1
Reason for Leaving #1
May we contact your previous supervisor for a reference? #1
Company #2
Phone #2
Address #2
Supervisor #2
Job Title #2
Starting Salary / Ending Salary #2
Responsibilities #2
From / To #2
Reason for Leaving #2
May we contact your previous supervisor for a reference? #2

I certify that my answers are true and complete to the best of my knowledge. 
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature*
Date:
Word Verification: