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WE ARE AN EQUAL OPPORTUNITY EMPLOYER. 
WE do not discriminate in hiring, or in terms and conditions of employment, because of an individual's race, religion, color, sex, and ancestry, national origin, disability or any other status protected by law or regulation.  

Please answer all questions as completely as possible.
Or, download a paper application form here. 

Today's Date
Today's Date
Personal Data
Your Name:
Your Name:
Current Address:
Current Address:
Phone:
Phone:
Do you have a bank account for direct deposit?
Do you have a legal right to work in the United States?
Have you been employed by Simonson's in the past?
Are you legally eligible for employment in the United States?
Have you ever been employed by Simonson's before?
Availability
What times of the day would you like to work?
Check all that apply
Education
Are you currently a student?
Work Experience
List all positions, starting with the present or most recent job.
Date Hired:
Date Hired:
Date Left:
Date Left:
Address:
Address:
Phone:
Phone:
Reason for leaving:
To the best of your knowledge, would this employer rehire you?
Date Hired:
Date Hired:
Date Left:
Date Left:
Address:
Address:
Phone:
Phone:
Reason for Leaving:
To the best of your knowledge, would this employer rehire you?
Date Hired:
Date Hired:
Date Left:
Date Left:
Address:
Address:
Phone:
Phone:
Reason for Leaving:
To the best of your knowledge, would this employer rehire you?
Other Information
Have you ever been discharged by an employer?
Have you ever been convicted of a felony?
Have you, or anyone under your supervision, been found to have violated prohibition on selling tobacco to minors?
Have you, or anyone under your supervision, been found to have violated a prohibition on selling alcohol to an underage person?
Note: A conviction does not automatically disqualify a job appliacant from further consideration; however, deception as to their existence or falsification of their exact nature may result in a denial of employment.
Applicant's Release
I AUTHORIZE Simonson Station Stores to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I release all persons, schools, employers, and law enforcement agencies supplying information concerning my background. I CERTIFY that the information on this application is correct and I understand that any misrepresentation or omission of any information will result in my disqualification from consideration for employment or, if employed, my dismissal. I UNDERSTAND that I will be required to successfully pass a drug screening and a background check as a condition of my employment. I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT, OFFER, OR PROMISE OF EMPLOYMENT. LIKEWISE, THE COMPANY CAN TERMINATE MY EMPLOYMENT AT AN TIME WITH OR WITHOUT CAUSE.
Date of Signature:
Date of Signature: