EYE DOCTOR'S OPTICAL OUTLETS EMPLOYMENT APPLICATION
Eye Doctor's Optical Outlets
5607 Johns Road
Tampa, FL. 33634
(813) 885-3937
www.opticaloutlets.com

First Name * Last Name * Middle Maiden Name E-mail Address * Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming --Territories-- American Samoa Federated States of Micronesia Guam Midway Islands Puerto Rico U.S. Virgin Islands Zip Time at your present address Phone * SSN Under 18 YesNo If yes how old are you? Position Applying For Desired Salary How many hours a week can you work? Work at night? YesNo Type of employment Full Time Part Time Full or Part Time Date Available to Start Available anytime Day(s) Available No Preference Monday Tuesday Wednesday Thursday Friday Saturday Sunday Education High School High School - Address High School - Years Attended High School - Area of Study or Degree College College - Address College - Years Attended College - Area of Study or Degree Business/Technical School Business/Technical School - Address Business/Technical School - Years Attended Do you have a drivers license? YesNo Driver License Number State of Issue Expiration Date Driver License Type: Operator Commercial (CDL) Chauffeur Type of transportation How many moving violations have you had in the last 3 years? Have you ever been convicted of a crime? If yes, please explain. Have you ever been in the Armed Forces? Date Entered Armed Forces Date Discharged from Armed Forces If yes, what branch? Specialty Are you a member of the National Guards or Reserves? NoYes Employment Employer Name Phone Address City State Zip Employment Start Date Employment Start Pay Employment End Date Employment End Pay Pay Type Name of Supervisor Your last job title Reason for leaving List the jobs you held, duties performed. skills used or learned, advancements or promotions while you worked at this company Employer Name: Phone Address City State Zip Employment Start Date Employment Start Pay Employment End Date Employment End Pay Name of Supervisor Your last job title Reason for leaving List the jobs you held, duties performed. skills used or learned, advancements or promotions while you worked at this company. Employer Name Phone Address City State Zip Employment Start Date Employment Start Pay Employment End Date Employment End Pay Pay Type Name of Supervisor Your last job title Reason for leaving List the jobs you held, duties performed. skills used or learned, advancements or promotions while you worked at this company. Typing: YesNo Typing WPM 10-Key YesNo Personal Computer YesNo Computer Type PCMac Other office skills References: Reference Name Position Company Address City State Zip Phone Reference Name Position Company Address City State Zip Phone List any other information you feel that may qualify you for position you are applying for in the area below To sign this application you must enter the following information: Your birth date and the last four digits of your SSN in the following format: mmddyyyyxxxx   Signature Date of application * Required