Employment Application

Position Information

Position(s) applying for — check all that apply

Cashier Opener Closer Online Order Fulfillment Other

If Other, please specify

Date of Application

How did you hear about this position?

Personal Information

First Name *

Middle Name

Last Name *

Preferred Name, if different

Phone Number *

Email Address *

Street Address

Apartment / Unit #

City

State

ZIP Code

Are you 18 years or older?

Yes No

If under 18, can you provide required proof of eligibility to work?

Yes No N/A

Are you legally authorized to work in the United States?

Yes No

Have you ever been employed by KountryCozy Outdoors before?

Yes No

If yes, when?

If yes, under what name?

Employment History

List your most recent employment first.

Employer 1

Company Name

Position

Employer Address

Dates Employed — From

Dates Employed — To

Reason for Leaving

May we contact this employer?

Yes No

Employer 2

Company Name

Position

Employer Address

Dates Employed — From

Dates Employed — To

Reason for Leaving

May we contact this employer?

Yes No

Employer 3

Company Name

Position

Employer Address

Dates Employed — From

Dates Employed — To

Reason for Leaving

May we contact this employer?

Yes No

References

Please list two professional references, not relatives.

Reference 1

Full Name

Relationship

Company

Phone Number

Email Address

Reference 2

Full Name

Relationship

Company

Phone Number

Email Address

Additional Information

Why would you like to work at KountryCozy Outdoors?

Do you have any skills or experience that you feel would help you in this position?

Résumé

Upload Résumé (Optional)

Optional. Accepted file types: PDF, DOC and DOCX. Maximum size: 5 MB.

Certification & Signature

I certify that the information I have provided in this application is true and complete to the best of my knowledge. I understand that false information, omissions, or misrepresentations may result in my application being disqualified or, if hired, my employment being terminated. I understand that this application is not a contract of employment.

I have read and agree to the certification statement above.

Electronic Signature — Type Full Name *

Signature Date *