Application for Employment

Instructions: Complete all necessary information. You may be asked to provide additional information on another form. This application will be kept on file. It is to your advantage to periodically check to keep it current and active.
Name*
First Last
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Position(s) Applied For*
- Retail Counter Staff
- Warehouse Stock Staff
- Office Staff, Administrative
What kind of employment would you be able to accept?
- Full-Time
- Part-Time
- Full-Time or Part-Time
Have you ever been employed with Arch Auto Parts before?*
- Yes
- No
Please give approximate dates of employment:*

Previous Employers and Their Addresses
Please indicate the employer(s) that you do not want us to contact. List the most recent employers first.
1. Company Name
Contact Name
Contact Phone
Company Address
Employment Dates
Position:
Reason for Leaving:
Last Wage
Can we contact this employer?
2. Company Name
Contact Name
Contact Phone
Company Address
Employment Dates
Position:
Reason for Leaving:
Last Wage
Can we contact this employer?
3. Company Name
Contact Name
Contact Phone
Company Address
Employment Dates
Position:
Reason for Leaving:
Last Wage
Can we contact this employer?
Employment Information
Do you have a legal right to be employed in the U.S.?*
(If yes, proof required before hiring)
Are you of a legal age to work?*

I understand that the Immigration Reform and Control Act of November 6, 1986 requires me to prove the legality of my residency or citizenship. I am also aware that the failure to provide such proof at the time of request may legally force my termination. To the best of my knowledge the information contained on this application is true. I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between me and this company for either employment or the provision of any benefits; and further understand that if an employment relationship subsequently is established, I will have the right to terminate my employment at any time and the company will have a similar right. In addition, I understand that no promise, representation, or agreement contrary to the foregoing is binding on the company unless made in writing and signed by me and an authorized representative of the company.
Signature
Date
MM
DD
YYYY
Comments
This field is for validation purposes and should be left unchanged.

Educational Background