GCS Application for Employment

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Wednesday - 7 pm

Thursday - 7 pm

Friday - 6 pm

Saturday - 7 pm

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Application For Employment

Denim and Diamonds - Wichita, Kansas

In compliance with State and Federal equal opportunity laws, qualified applicants are considered for all positions, without regard to race, color, religion, sex, national origin, age or marital status.

Date

Your Last Name

Your First Name, Middle Initial

Street Address

City

State

Zip Code

Home Phone

Business Phone

Email Address

Social Security #

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Type of Work

Full TIme
Temporary
Temp to Hire

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Position Desired

Are you 21 years of age or older?

Yes
No

Are you a United States Citizen?

Yes
No

Are you willing to relocate?

Yes
No

Referred by

Date you can start

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Are you willing to take a urinalysis test before and during work hours?

Yes
No

Have you been convicted of a criminal offense other than a traffic ticket?

Yes
No

If the answer to the privious question is yes, list the date.

Please list the place the offense occured.

Nature of the Offense:

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Most Recent Employment

Employer

Address

City

State

Zip Code

Job Title

Employed From

Employed To

Reason for Leaving

May we contact this employer?

Yes
No

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Personal Reference

Name

Address

City

State

Occupation

May we contact this person?

Yes
No

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Comments

Please list any degrees, diplomas, academic achievements or memberships in any professional organizations that are related to the position for which you have applied.

Please list any previous experience you may have that is related to the position for which you have applied.

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