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1-800-798-1000

info@midbellmusic.com

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Saturday 9:00-5:00

Sunday 1:00-5:00

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		Date
First Name	Middle Name	Last Name
Address	City
State	Zip Code

Home Phone

Last 4 Digits of Social Security Number

Cell Phone

Date of Birth

Email

Position Applied For

Salary or Hourly Rate expected

Week Hour

Desired Hours

Are you currently employed?	Yes No
May we Contact your present employer?	Yes No
Are you 18 Years or Older?	Yes No
Are you prevented from lawfully becoming employed in this country due to Visa or Immigration status? (Proof of citizenship or immigration status is required upon employment)	Yes No

You are available to Work: (check all that apply)	Full Time Part Time Evenings On Call Temporary Weekends Shift Work
Date you can Begin Work:
Have you been convicted of a crime within the last seven (7) years? (Other than a traffic violation.) (Conviction will not necessarily disqualify an applicant from employment)	Yes No

If Yes, Please Explain:

EDUCATION

	Currently Enrolled?	School Name & Address	Credits Earned	Major	Diploma/Degree	Month/Year Completed
Elementary School	---		---	---	---	---
High School	Yes No		---	---
College	Yes No
Graduate	Yes No

List below ALL present and past employment, beginning with your most recent and ending with your VERY FIRST job. All times must be accounted for whether employed or not. Additional space is provided below.

Name & Address of Company and Type of Business	From	To	Describe in detail work you did and your title	Weekly Start Salary or Hourly Rate	Weekly End Salary or Hourly Rate	Reason for Leaving	Name, Title and Phone Number of Your Supervisor

Additional Jobs

Optional Pre-Employment Survey...

Please tell us about yourself!

Do you play a musical instrument?	Yes No
If yes, what instrument(s)?
Would you consider yourself...	Amateur Semi-Professional Professional
Have you taught music?	Yes No
Have you ever worked in a music store?	Yes No
What do you find appealing about working in a music store?
Have you ever purchased music products for your own personal or institutional use?	Yes No
If yes, where do you customarily make your musical purchases? (Name of store)
Why?

What computer skills do you have?

Windows	None	Some (minimal)	Average	Expert
Mac	None	Some (minimal)	Average	Expert
Word	None	Some (minimal)	Average	Expert
Excel	None	Some (minimal)	Average	Expert
Outlook	None	Some (minimal)	Average	Expert
Publisher	None	Some (minimal)	Average	Expert
Network	None	Some (minimal)	Average	Expert

Do you utilize the internet?	None Some Lots
What purpose does the internet serve for you?
Please describe your "ideal" job

End of optional Pre-Employment survey

IMPORTANT NOTICE: A Credit / PEER (Pre Employment Evaluation Report) is required prior to employment. This notice is in compliance with federal fair credit reporting act sections 604(a)(3)(A). I hereby authorize Ray's Midbell Music to procure a credit report and background check.

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