Corporate Offices:

475 Westfield Road

Charlottesville Va 22901

Fax: 434.978.4162

Applicant Information

Last Name

 

First

 

M.I.

Date

 

Street Address

 

Apartment/Unit #

 

City

 

State

 

ZIP

 

Phone

 

E-mail Address:

D.O.B        /       /

Date Available

 

Social Security No.

 

Desired Salary

 

Are you a citizen of the United States?

YES 

NO 

If no, are you authorized to work in the U.S.?

YES 

NO 

Do you have a valid driver’s license?

YES  

NO  

DL #

 

Have you ever been convicted of a felony?

YES  

NO  

If yes, explain

 

Type of hours requested: Full Time   Part Time                            Can you work weekends? YES    NO 

Hours Available:

 

Monday:_______________________    Wednesday:__________________________    Friday:_____________________ Sunday:____________

 

 

Tuesday:_______________________   Thursday:____________________________    Saturday:___________________

 

Education

High School

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

College

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

Other

 

Address

 

From

 

To

 

Did you graduate?

YES 

NO 

Degree

 

 

References

Please list three professional references.

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

Full Name

 

Relationship

 

Company

 

Phone

(           )

Address

 

 

Previous Employment (If you have retail experience please make sure to include it below)

Company

 

Phone

(           )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

Company

 

Phone

(         )

Address

 

Supervisor

 

Job Title

 

Starting Salary

$

Ending Salary

$

Responsibilities

 

From

 

To

 

Reason for Leaving

 

May we contact your previous supervisor for a reference?

YES 

NO 

 

 

Military Service

Branch

 

From

 

To

 

Rank at Discharge

 

Type of Discharge

 

If other than honorable, explain

 

 

GENERAL INFORMATION

Sports and Hobbies you participate in or are interested in:

Please explain below why you feel Freestyle should hire you. Give us the information that you feel sets you apart from the rest of the applicants and would give us a reason to call you in for an interview.

 

 

 

 

 

 

 

 

 

 

Disclaimer and Signature

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.

I hereby give consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information.

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The documents will be used for completion of Form I-9.

I hereby acknowledge that I have read and agree to the above statements.

Signature

 

Date