Pure Health Bar at Cherry Hill Mall

Online Application

Fields with "*" are required.

Personal Information
First Name	Last Name	10-Digit Home Phone
A value is required.*	A value is required. *	A value is required. *
		ex: 555-123-4567

Mailing Street Address	City	State and Zip Code
A value is required. *	A value is required. *	A value is required. and A value is required. *

E-Mail Address	Other/Cell Phone Number
Leave blank if you don't have an email.	ex: 555-123-4567

Are you over the age of 18? (if no, you will be required to furnish a work permit if hired)
Yes No

Are you legally able to be employed in this country? (If hired, verification will be required by law)
Yes No

Have you ever been convicted of a felony, violent crime, or a retail related crime (including, but not limited to, shoplifting, or other theft), breach of trust or dealing in illegal drugs?
Yes No
If yes, please describe:


Employment History
Name of present or previous employer	Job Title/Responsibilities	Supervisor's Name


Address	City	State, Zip
		,

Phone Number	Starting Salary/Rate $	Ending Salary/Rate $
ex: 555-123-4567	(ex: $30,000 or $7.25/hour)	(ex: $30,000 or $7.25/hour)

Employed From (month / year)	to



Name of previous employer	Job Title/Responsibilities	Supervisor's Name


Address	City	State, Zip
		,

Phone Number	Starting Salary/Rate $	Ending Salary/Rate $
ex: 555-123-4567	(ex: $30,000 or $7.25/hour)	(ex: $30,000 or $7.25/hour)

Employed From (month / year)	to



Name of previous employer	Job Title/Responsibilities	Supervisor's Name


Address	City	State, Zip
		,

Phone Number	Starting Salary/Rate $	Ending Salary/Rate $
ex: 555-123-4567	(ex: $30,000 or $7.25/hour)	(ex: $30,000 or $7.25/hour)

Employed From (month / year)	to

Do we have your permission to contact your current or previous employers? Yes No

EDUCATION
Type of School	Name of School	City and State	Area of Study	Years Completed	Diploma/Degree?
High School					Yes No N/A
College					Yes No N/A
Graduate					Yes No N/A
Other					Yes No N/A

REFERENCES

Please list three references (other than relatives) we may contact.

Name	Contact Phone / Email	Address, City, Zip	Occupation


Name	Contact Phone / Email	Address, City, Zip	Occupation


Name	Contact Phone / Email	Address, City, Zip	Occupation

HOURS AVAILABLE*All time slots are required. When Not Available, choose "N/A".

	SUNDAY	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
From	Please select an item.	Please select an item.	Please select an item.	Please select an item.	Please select an item.	Please select an item.	Please select an item.
To	Please select an item.	Please select an item.	Please select an item.	Please select an item.	Please select an item.	Please select an item.	Please select an item.

Total hours available per week

Date available to start work

A value is required.

Format 01/01/2011

What type of work are you seeking?

Part-Time Full-Time Seasonal

Applicant's Acknowledgment

I certify that the information given on this application is true and complete to the best of my knowledge. I understand that false or misleading information given, or information omitted by me on this application or in interviews will be sufficient cause to disqualify me from further consideration for employment.

I authorize all past employers, educational institutions and personal references (unless otherwise indicated) to release any and all information concerning my past employment work history, performance and personal character. I hereby release all such employers, personal references, and Pure Health Bar from any and all liability resulting from damages I may incur in the reference verification process.

I understand that if employed at Pure Health Bar, my employment is "at will" which means that if I am hired, I am free to resign at any time, with or without cause and with or without prior notice; and if I am hired, Pure Health Bar may terminate my employment at any time with or without cause and with or without notice.

If called for an interview, I am able to provide my Social Security Number for any additional forms.

* I have read and fully understand this Acknowledgment. *REQUIRED Please read the Applicant's Acknowledgment section above and check the box before submitting.

Security Verification

Type in the security image below, it is case sensitive, and click submit to complete your application.

*

If you are not directed to a "Thank You" page after submitting your form, please scroll up and look for empty required fields. Thank you!