Employment

Please fill out the form below or download an employment application to print and fill out. Then bring the form in to any Shoppers Supply location. If you need help filling out this application, please let us know and every effort will be made to accommodate your needs in a reasonable amount of time. All applications will receive consideration without unlawful discrimination because of race, creed, religion, color, sex, age, national origin, disability, marital status, sexual preference, or gender identity.

Download employment application form (PDF)

Employment Form

Contact Information

First:^*

Middle:

Last:^*

Email Address:^*

Location Applying For:^*

Street Address:^*

City:

State:

Zip Code:

Primary Phone Number:^*

Secondary Phone Number:

General Information

Do you have a legal right to work in the United States full time?^*

Yes

Are you at least 18 years of age?^*

Yes

What position(s) are you applying for?^*

When will you be available to begin work?

Have you ever been employed by us?^*

Yes

If yes, give dates you were employed:

Starting Date: From

Ending Date: To

Position held:

Reason for leaving:

Have you ever been terminated from a job?^*

Yes

If so, state the name of the employer who terminated you, the date of termination, and the reason why you were terminated.?

Employer:

Date of Termination:

Reason for termination:

Education

High School

High school name:^*

City:

State:

Major subject:

Years completed:

Diploma or Degree Received:^*

Yes

College

College name:

City:

State:

Major subject:

Years completed:

Diploma or Degree Received:

Type:

Trade School

Trade school name:

City:

State:

Major subject:

Years completed:

Diploma or Degree Received:

Type:

Employment History

List your current or most recent employer first and indicate a continuous record of employment for the last ten years or from the time you left school.

If you are currently employed, may we contact your employer about this application?^*

Yes

Employer:^*

Phone:

Address:

Supervisor's Name:

Job title/duties:

Employed From:

Employed To:

Starting rate: $

Rate frequency: Per

Ending rate: $

Rate frequency: Per

Employer:

Phone:

Address:

Supervisor's Name:

Job title/duties:

Employed From:

Employed To:

Starting rate:

Rate frequency: Per

Ending rate: $

Rate frequency: Per

Employer:

Phone:

Address:

Supervisor's Name:

Job title/duties:

Employed From:

Employed To:

Starting rate: $

Rate frequency: Per

Ending rate: $

Rate frequency: Per

Employer:

Phone:

Address:

Supervisor's Name:

Job title/duties:

Employed From:

Employed To:

Starting rate: $

Rate frequency: Per

Ending rate: $

Rate frequency: Per

Please explain any gaps in your employment history:

List any professional, trade groups, organizations or special skills that you consider relevant to your ability to perform this job:

Background Information

Were you in the military? ^*

Yes

Branch:

Do you have any experience from your military service that would be relevant to the job(s) for which you are applying? If yes, please explain:

Have you ever been convicted of a crime other than a parking violation or speeding citation?^*

Yes

If yes, explain 1) nature of the crime, 2) date of conviction and 3) state or jurisdiction in which convicted.

Do you have any pending criminal charges against you?^*

Yes

If yes, describe 1) nature of charges, 2) date issued and 3) county and state where issued.

Note: A conviction will not automatically disqualify an applicant for a particular job. The type and seriousness of the crime, the frequency of violations, the date of conviction, and the applicant’s entire work and educational history will be considered.

Have you been given a job description or had the requirements of the job explained to you?^*

Yes

Please Read Carefully Before Submitting

I Understand:

That submitting this application does not constitute an offer of employment and that my application may be rejected for any reason.

That giving false or misleading information on this form or in an interview is grounds for denial or immediate termination of employment.

That I may be required to complete a medical history form and may be required to be examined by a medical professional designated by the company at the post-offer stage. I agree that this organization shall be entitled to receive full and complete reports and records governing any medical or related examinations, and I authorize any and all such doctors, medical examiners, and clinics/hospitals to give to this organization full and complete reports and records covering such examinations. Prior to commencing employment, all successful applicants must satisfactorily complete a post-offer pre-employment physical to ensure that the applicant is physically able to perform the essential functions of the job.

That use of illegal drugs is prohibited during employment and that I may be required to undergo and successfully pass a screening for alcohol and/or drugs that is included in a pre-employment physical examination. I also understand that, if employed, I may be required to submit to an alcohol or drug screening according to state law. I agree that this organization shall be entitled to receive full and complete reports and records governing any alcohol or drug screening, and I authorize any and all such doctors, medical examiners, and clinics/hospitals to give to this organization full and complete reports and records covering such examinations. I understand that testing positive for the use of illegal drugs may and likely will result in my not being offered employment.

That if I sustain any injury or illness while in the employment of this organization, I agree that this organization shall be entitled to receive full and complete reports and records governing any medical or related examinations, and I authorize any and all such doctors, medical examiners, and clinics/hospitals to give to this organization full and complete reports and records covering such examinations, condition, care and treatment related to or resulting from the alleged illness or injury.

I Understand:

That this application will be active for a period of 60 days, after that time, if I wish to be considered for employment, I must submit a new application.

Authorization to Release Information

If I am given a conditional offer, I authorize this organization to make a complete investigation of me, including but not limited to my past employment history, scholastic records, criminal activity, motor vehicle driving records, and to receive the results of any physical examination, including the results of alcohol or drug screening, I may be required to undergo and to rely on such information sources. I understand that this organization may request an investigative consumer report from a consumer-reporting agency that includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that the investigative consumer report may involve personal interviews with my neighbors, friends, relatives, former employers, schools, and others. I also understand that under the Federal Fair Credit Reporting Act I have the right to make a written request to this organization within a reasonable time, for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation. I authorize all persons and organizations to release any information concerning my background and hereby release all persons and organizations from liability for any damage whatsoever for this information. I acknowledge that a telephone facsimile (fax) or photographic copy shall be as valid as the original. I understand that if employment is obtained under this application, I will comply with all rules and policies of the company. I agree to be responsible for company property and equipment issued to me by the company until returned by me. I agree to pay for property and equipment not returned, and authorize the company to withhold an amount equal to the value of the property not returned by me from final pay. I agree that this authorization to withhold wages constitutes a bona fide written authorization as required under Chapter 91A of the Iowa Code or any similar statute in any other state to withhold wages, and that it is for my benefit that I have provided this authorization.

I understand that this employment application and any other employee related documents are not contracts of employment and that this organization follows an “employment-at-will” policy that an individual who is hired may voluntarily leave employment, and may be terminated by the employer at any time and for any or no reason. I understand that any oral or written statements to the contrary are hereby expressly disavowed and should not be relied upon.

I have read and understand the above release and authorization. If I did not understand, I have had the opportunity to ask questions and obtain any additional information to allow me to understand. I am freely and voluntarily submitting this application.

^* Required Fields