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Application For Employment

Position Applied for: Date:

Bo's Smoke Shops consider all applicants for employment without regard to race, color, religion, sex, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law. Bo's Smoke Shops also provide reasonable accommodations to qualified individuals in accordance with the Americans With Disabilities Act and applicable state and local laws.

First Name:		Middle Initial:		Last Name:
		Phone:		Referred By:

Address:

City:

State:

Zip:

Is there anything that would prevent you from performing in a reasonable and safe manner the activities involved in the position for which you have applied? Yes No

If yes, please Explain?

*A conviction record will not necessarily be a bar to employment. This information will be used only for job-related purposes and only to the extent permitted by applicable law.

Federal laws require that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with such laws, Bo's Smoke Shops will verify the status of every individual offered employment with the company. In this connection, all offers of employment are subject to verification of the applicant's identity and employment authorization, and if hired, it will be necessary for you to submit such documents as are required by law to verify your identification and employment authorization.

Do you have a legal right to work and remain in the United States? Yes No

State name(s) of any relative(s) in our employ and your relationship to them:

Name: Relationship:

Record of Education
School and Address:	Course of Study:	# of Yrs Completed:	Did you Graduate?	Diploma/Degree Received:
			Yes No
			Yes No
			Yes No
			Yes No

Prior Work History	(List in order, last or current employer first.)
Dates (From - To):	Name, Address and Telephone Number of Employer:	Rate of Pay Start/Finish:	Reason For Leaving:

Describe briefly the work you performed:

Military Service Record

Have you ever served in the U.S. Armed Forces? Yes No
If yes, list duties in the Service, including special training that is relevant to the position for which you have applied.

Skills

Are there any other experiences, skills or abilities that you feel especially qualify you for work with our company?

Personal References	"Excluding Relatives"
Name and Occupation	Years Acquainted	Address	Phone

Pre-Employment Statement - Please read carefully and sign the statement below.

I understand and agrees that:

The information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume' or any other materials, or during any interviews, can be justification of refusal of employment, or, if employed, termination from Bo's Smoke Shops employ.
Any offer of employment I may receive from Bo's Smoke Shops is contingent upon my successful completion of the company's total pre-employment screening process, including the company's receiving references that consider satisfactory.
I understand that as a condition of employment, I will be required to undergo and successfully pass a screening for drugs. I also understand and agree that, if employed, I may be required to submit to an alcohol or drug screening at any time at the discretion of Bo's Smoke Shops. I hereby consent to having the results of any such alcohol or drug screening disclosed to Bo's Smoke Shops Personnel Director.
I authorize and request that all of my present and former employers and those individuals I have listed as personal references furnish information about my employment record, including a statement of the reason for the termination of my employment, work performance, abilities, and other qualities pertinent to my qualifications for employment, hereby releasing them from any and all liability for damages arising from furnishing the requested information.
I understand that, if reasonable accommodation is required due to a disability, I must inform the Human Resources Department. I will also state specific accommodations I will require.
In consideration of my employment, I agree to comply with the policies, rules, regulations and procedures of the company and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of either the company or myself. I further understand that no manager or representative of the company, other than the President, has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from or contrary to the foregoing. I further understand that any such agreement, if made, shall not be enforceable unless it is in writing and signed by me and the President.

In case of an emergency notify
Name:	Address:	Phone:

Attach File

Attach your resume or another file.

Top of Page

Are you over the age of 18? Yes No If not, state your age:	Have you ever been employed by us? Yes No If yes, when?
Are you willing to work overtime as necessary? Yes No	Date you can start:
Are you willing to work second or third shift? Yes No	Salary Desired:
Do you want to work: Full Time Part Time If part time, specify days and hours:	Have you ever been convicted of a crime?* Yes No If yes, state nature of the offense, when, where and disposition:

Application For Employment

Record of Education

Prior Work History

Military Service Record

Skills

Personal References

Attach File