NickelRama Employment Application Order Number First Name * Middle Name * Last Name * Date of Birth * Referred By Today's Date * Phone Number * SSN * Email Address * Residential Address * City * Zip Code * Position Desired * Trainee Attendant Staff Attendant Customer Service Coordinator Operations Coordinator Opener Closer Shift Leader Supervisor Assistant Manager Arcade Manager Operations Manager Administrative Manager Customer Service Manager Date Available To Start * Wage Desired Currently Employed? * Yes No If Yes, May We Contact Current Employer? Yes No High School Attended * Dates Attended * Did You Graduate? * Yes No Extra Curricular Activities College or Trade School Dates Attended Did You Graduate? Yes No Extra Curricular Activities Employment History #1 Total Length Of Time Employed With This Company Position I Currently Work Here Yes No Wage If No, Reason For Leaving Employment History #2 Total Length Of Time Employed With This Company Position I Currently Work Here Yes No Wage If No, Reason For Leaving Employment History #3 Total Length Of Time Employed With This Company Position I Currently Work Here Yes No Wage If No, Reason For Leaving Reference #1 Phone Number Years Known Reference #2 Phone Number Years Known Reference #3 Phone Number Years Known What Are Your Hobbies? What Special Skills or Training Makes You Unique? What is or was your MOST favorite class? What is or was your LEAST favorite class? I Authorize & Agree To The Conditions Below * Yes, I Agree I certify, by turning in this application that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Information Summary
