Hensley's IGA

Employment Application

Print this application (3 pages)

Drop off at the Service Desk

Location #1 Maynardville_____________

Location #3 Norris__________________

Today's Date:_______________________________________________________________________________

Name:_____________________________________________________________________________________

Street Address:______________________________________________________________________________

City, State, Zip Code:_________________________________________________________________________

Telephone Number:__________________________________________________________________________

Circle One:     Male      or       Female

Social Security Number: ______-______-______

Tennessee Driver's License Number:___________________________________________________________

Date of Birth:______________________________________

Circle One:      Married    or     Single

Spouse's Name_____________________________________________________________________________

Spouse's Occupation_________________________________________________________________________

Any Children?____________________________

If so, What age?-________________________________________________________________

What date can you start?_________________________________________________________

What category would you prefer?     Full -Time      or     Part- Time

Which schedules are you available?    Weekdays     Weekends    Evenings    Nights     Sundays

Are you presently attending school?     Yes  or    No    What grade?__________________________________

Are you involved in any school related activities?    Yes   or   No 

If yes, what activity are you involved in?________________________________________________________

Highest grade completed in school?_____________________

If 18 years or younger:

Parents Name:_____________________________________________________________________________

Parents Address:___________________________________________________________________________

Telephone Number:_________________________________________________________________________

Name, Address & Telephone Number of Last Employers:

(Most Recent First)

1.____________________________________________

_____________________________________________

_____________________________________________

Are you currently working for this employer?    Yes    or     No

If yes, may we contact the employer?        Yes   or     No

Salary per hour?_______________________________________

Reason for leaving?_______________________________________________________________________

________________________________________________________________________________________

2._________________________________________

__________________________________________

__________________________________________

Salary per hour?______________________________________

Reason for leaving?___________________________________

Name, Address & Telephone numbers of three references outside your immediate home:

1._____________________________________________

______________________________________________

______________________________________________

2._____________________________________________

______________________________________________

______________________________________________

3._____________________________________________

______________________________________________

______________________________________________