Ups Store Part-Time

Updated April, **** The UPS Store

Mail Boxes Etc.

Application for Employment

Name Date

Last First Middle

Address

Street City State Zip Code

Telephone # Other Phone # Social Security # Referred by

Position(s) applied for Date available

Type of employment desired Full-Time Part-Time Temporary Seasonal Educational Co-Op

Salary desired If currently employed, may we contact your employer? Yes No Are you legally eligible for employment in this country? Yes No If you are under 18 and it is required, can you furnish a work permit? Yes No Are you available to work overtime if required? Yes No Have you applied with MBE/The UPS Store before? Yes No Have you been employed at MBE/The UPS Store before? Yes No If yes, when? and at what location?

Do you have any friends or family employed at this location? Yes No Have you been convicted of a crime in the last seven (7) years? Yes No If yes, please explain

CONVICTION WILL NOT NECESSARILY BE A DISQUALIFICATION FOR EMPLOYMENT. EDUCATIONAL BACKGROUND

List previous three (3) educational institutions attended, beginning with the most recent. DEGREE(s)/DIPLOMA(s)

SCHOOL CITY, STATE GRADUATED? EARNED

Yes No

Yes No

Yes No

Updated April, 2003 The UPS Store

Mail Boxes Etc.

EMPLOYMENT BACKGROUND

Provide the following information beginning with the most recent employer. EMPLOYER TELEPHONE DATES EMPLOYED SUMMARIZE THE TYPE OF WORK FROM TO PERFORMED AND JOB RESPONSIBILITIES

ADDRESS

JOB TITLE HOURLY

RATE/SALARY

STARTING

IMMEDIATE SUPERVISOR AND TITLE $ per

REASON FOR LEAVING HOURLY

RATE/SALARY

FINAL

MAY WE CONTACT FOR REFERENCE? $ per

Yes No Later

EMPLOYER TELEPHONE DATES EMPLOYED SUMMARIZE THE TYPE OF WORK FROM TO PERFORMED AND JOB RESPONSIBILITIES

ADDRESS

JOB TITLE HOURLY

RATE/SALARY

STARTING

IMMEDIATE SUPERVISOR AND TITLE $ per

REASON FOR LEAVING HOURLY

RATE/SALARY

FINAL

MAY WE CONTACT FOR REFERENCE? $ per

Yes No Later

EMPLOYER TELEPHONE DATES EMPLOYED SUMMARIZE THE TYPE OF WORK FROM TO PERFORMED AND JOB RESPONSIBILITIES

ADDRESS

JOB TITLE HOURLY

RATE/SALARY

STARTING

IMMEDIATE SUPERVISOR AND TITLE $ per

REASON FOR LEAVING HOURLY

RATE/SALARY

FINAL

MAY WE CONTACT FOR REFERENCE? $ per

Yes No Later

EMPLOYER TELEPHONE DATES EMPLOYED SUMMARIZE THE TYPE OF WORK FROM TO PERFORMED AND JOB RESPONSIBILITIES

ADDRESS

JOB TITLE HOURLY

RATE/SALARY

STARTING

IMMEDIATE SUPERVISOR AND TITLE $ per

REASON FOR LEAVING HOURLY

RATE/SALARY

FINAL

MAY WE CONTACT FOR REFERENCE? $ per

Yes No Later

Updated April, 2003 The UPS Store

Mail Boxes Etc.

COMMENTS INCLUDING EXPLANATION OF ANY GAPS IN EMPLOYMENT: REFERENCES

List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please).

YEARS PHONE

NAME RELATIONSHIP ACQUAINTED NUMBER I certify that all the information I have provided is true, complete and correct. I authorize Mail Boxes Etc. to investigate all statements contained on this application. I understand that any misrepresentation or omission of facts called for is cause for immediate disqualification and/or if employed, immediate dismissal.

Furthermore, I understand and agree that if employed, I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same rights to terminate my employment at any time, with or without prior notice, except as may be required by law. This application does not in any way constitute an agreement or contract for employment. I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States.

Applicant’s Signature Date

Contact this candidate