Last Name:

First Name:

Middle Initial:

Which Store Are You Applying For:
Email Address:
Social Security Number:
Street Address:
City, State, Zip:
Phone:

Are you over 18 years of age? YesNo

Have you ever been convicted of a crime including non traffic summary offenses? YesNo If yes, give date, place, and disposition:

Can you, upon employment, submit verification of your legal right to work in the U.S.? YesNo

How did you learn of Kennie's? Newspaper (name) Employee (name) Friend (name) Newspaper (name)

Have you ever worked for Kennie's? YesNo If yes, give dates and location.

Do you have access to adequate transportation to travel to and from work? YesNo If no, please explain.

Type of work desired:

AVAILABILITY (Please indicate times)

	MON	TUE	WED	THU	FRI	SAT	SUN
FROM
TO
Type of Employment Desired: Full-TimePart-Time

EDUCATION

Select Highest Grade Completed: Elementary 1Elementary 2Elementary 3Elementary 4Elementary 5Elementary 6Elementary 7Elementary 8High School 9High School 10High School 11High School 12College 1College 2College 3College 4College 5College 6College 7College 8

Name & Address of High School:

College Name	City & State	Major/GPA	Degree	Date Completed

Other School/Training	Courses	Certificate	Course Length	Date Completed

EMPLOYMENT RECORD

Most Recent Company

Date Started

Date Ended

Company Name

Company Address:
Job Title:	Starting Salary $ Ending Salary $
Duties:
Supervisor Name:
Reason for Leaving:

Next Most Recent Company

Date Started

Date Ended

Company Name

Company Address:
Job Title:	Starting Salary $ Ending Salary $
Duties:
Supervisor Name:
Reason for Leaving:

Next Most Recent Company

Date Started

Date Ended

Company Name

Company Address:
Job Title:	Starting Salary $ Ending Salary $
Duties:
Supervisor Name:
Reason for Leaving:

Have you ever been disciplined or fired? YesNo If yes, describe.

EMPLOYMENT REFERENCES (prefer past supervisors)

Name & Occupation	Company	Phone Number

CERTIFICATION and AUTHORIZATION (please read thoughtfully and carefully)

I certify that the information contained in this application is correct, to the best of my knowledge and I acknowledge that Kennie’s is relying on the accuracy of the information provided. I authorize Kennie’s to verify the accuracy of the information provided herein, and I authorize former employers, educational institutions and credit agencies to release information concerning me to Kennie’s. I also authorize Kennie's to give references and provide information about me in response to inquiries subsequent to my employment if hired. I understand that falsification, misrepresentation or omission of requested facts may result in denial of employment or, if employed, may result in immediate dismissal. I understand and agree that I must produce applicable documents showing that I am a United States Citizen or alien lawfully authorized to work in the United States, within the time frame specified by Kennie’s, to meet the Immigration Reform and Control Act of 1986 requirements. If I fail to comply with any of the requirements set forth above, I understand that an offer of employment will be rescinded or my employment will be terminated. In consideration of my employment with Kennie’s, I agree to conform to the Company’s policies, rules and regulations. I understand and agree that my employment is at-will, and therefore, my employment and compensation can terminate, with or without cause, and with or without notice, at any time, at my option or at the Company’s option. I further understand and agree that this at-will employment relationship as defined above will remain in effect throughout my employment with Kennie’s. I also understand and agree that no one has the authority to promise me job security or continued employment, except the President of the Company in formal written agreement signed by both of us.

By checking "I Agree" and submitting this employment application, I acknowledge that the information I have provided is accurate, that I have read the certification and agreement, and that I agree to abide by its terms.

Electronic Signature: