Bluegrass Vape Employment Application Form

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Personal Information

E-Mail:*

First Name:*

Middle Initial

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Cell Phone:*

Work Preference

Date Available*

Employment Requested:*
Full Time
Part Time
Temporary

What days and hours are you available to work?*

Education

High School Name/Location:*

Diploma Received:*
Diploma
Equivalency
None

Date graduated:*

College Name/Location:

Degree Earned:

Attended from:

Attended To:

Major/Minor:

College Name/Location:

Degree Earned:

Attended from:

Attended To:

Major/Minor:

Employment History

Name Of Employer:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Employed From:*

Employed To:*

Employer Phone:*

Job Title:*

Supervisor Name:*

Ending pay rate:*

Reason For Leaving:*

Name Of Employer:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Employed From:

Employed To:

Employer Phone:

Job Title:

Supervisor Name:

Ending pay rate:

Reason For Leaving:

Special Skills Section

Related Knowledge/Skills:

Professional References

Please list three references that have knowledge of your professional experience.

Reference Name:

Address:

Occupation:

Phone:

Reference Name:

Address:

Occupation:

Phone:

Reference Name:

Address:

Occupation:

Phone:

Background

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR?*

Yes No

HAVE YOU EVER PLED NO CONTEST OR GUILTY TO A FELONY OR A FIRST DEGREE MISDEMEANOR?

Yes No

ARE YOU A U.S. CITIZEN OR ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?*

Yes No

DO YOU VAPE?*

Yes No

DO YOU SMOKE OR USE OTHER TOBACCO PRODUCTS?*

Yes No

ARE YOU COMFORTABLE WORKING ALONE IN A RETAIL VAPE SHOP?*

Yes No

ARE YOU AT LEAST 21 YEARS OF AGE?*
Yes No 

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