EYE DOCTOR'S OPTICAL OUTLETS EMPLOYMENT APPLICATION
Eye Doctor's Optical Outlets
5709 Johns Road
Suite1209
Tampa, FL. 33634
(813) 885-3937
www.opticaloutlets.com

 

Last Name: First Name: Middle Initial: Maiden Name: Email:
Address: City: State: Zip:
How long have you lived at your present address? Phone: SSN: Are you under the age of 18? If yes how old are you?
Years Months
Position you are applying for: Desired Salary: How many hours a week can you work? Are you willing to work at night?

 

 

Type of employment desired:
 Date available to start work (MM/DD/YYYY):
 Available anytime?
 No Preference Thursday:
Monday: Friday:
Tuesday:: Saturday:
Wednesday Sunday:

 

 

EDUCATION
High School Address: Number of years attended: Area of study or Degree earned:
College/University Address: Number of years attended: Area of study or Degree earned:
Business/Technical School Address: Number of years attended: Area of study or Degree earned:
Other Address: Number of years attended: Area of study or Degree earned:

 

 

Do you have a drivers license? Driver License Number: State of Issue: Expiration Date: Driver License Type:
Operator
Commercial (CDL)
Chauffeur
Type of transportation: How many accidents have you had in the last 3 years? 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:
Date Discharged:
If yes, what branch?
Specialty:

Are you a member of the National Guards or Reserves? 		 

 

EMPLOYMENT HISTORY
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:
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:
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: Typing WPM: 10-Key: Personal Computer
Computer Type: Other office skills:    
   

 

REFERENCES
Reference One Reference Two
Name: Name:
Position: Position:
Company: Company:
Address: Address:
City City
State State
Zip Zip
Phone: 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: