DIETSCH BROTHERS

Employment Application

MAIN STORE

400 West Main Cross Street, Findlay, Ohio 45840

419-422-4474 (Phone) / 419-424-5597 (Fax)

EAST STORE

1217 Tiffin Ave., Findlay, Ohio 45840

419-423-3221 (Phone) / 419-422-1199 (Fax)

POSITION YOU ARE SEEKING:_________________________________

STORE YOU WOULD LIKE TO WORK AT: MAIN OR EAST

Applicant Information

Full Name:

Date:___________________

Last

First

M.I.

Address:

Street Address

Apartment/Unit #

City

State

ZIP Code

Phone:

( )

Date of Birth:

Social Security No : __________________________________

Emergency Contact Name: ____________________________________ Phone Number: ________________________ Relationship: __________________________________________________

Education

High School:

(Expected) Graduation Year:___________________________________

School/Church Activities: ________________________________________________________________________

College:

(Expected) Graduation Year: __________________________________

School Activities: _____________________________________________________________________________________

References

Please list one or two references.

Full Name:

Relationship:

Company:

Phone:

( )

Full Name:

Relationship:

Company:

Phone:

( )

Previous Employment

Company:

Phone:

( )

Job Title:

Supervisor:

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

YES

NO

Company:				Phone:			( )
Job Title:						Supervisor:
Responsibilities:
From:	To:	Reason for Leaving:
May we contact your previous supervisor for a reference?			YES		NO

Company:				Phone:			( )
Job Title:						Supervisor:
Responsibilities:
From:	To:	Reason for Leaving:
May we contact your previous supervisor for a reference?			YES		NO

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:

Date:

COMMENTS (TO BE FILLED OUT BY DIETSCH BROTHERS):

Interviewed By (if applicable):

Date Hired (if applicable):