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Employment Application
The Company is firmly committed to prohibiting and eliminating employment discrimination on the basis of race, color, gender, sexual orientation, age, religion, national origin, disability, marital, or veteran status, or any other legally protected status. Massachusetts statutory provisions specifically prohibit employers from (1) terminating or refusing to hire individuals on the base of genetic information; (2) requesting genetic information concerning employees, applicants or their family members; (3) attempting to induce individuals to undergo genetic tests or otherwise disclose genetic information; (4) using genetic information in any way that affects the terms and conditions of an individual’s employment; or (5) seeking, receiving or maintaining genetic information for any non-medical purpose. Massachusetts General Laws c.151B defines “genetic information” as any written record or explanation of a genetic test of a person’s family history with regard to the presence, absence or variation of a gene. A genetic test is defined as “any test of DNA, RNA, mitochondrial DNA, chromosome or proteins for the purpose of identifying genes or genetic abnormalities.” The law expressly excludes drug and alcohol tests from this definition, meaning that employers may continue to conduct such tests in accordance with existing legal requirements. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. If any statements made by applicants are found to be false or inaccurate, it is considered a breach of the Company’s interest and is grounds for disqualification of employment or immediate dismissal.
Please complete all sections as applicable
.
Attach Resume (optional)
You can attach 1 file
- Include cover letter (if applicable) in same file as resume. Only Microsoft Word (.doc) or PDF file formats accepted.
Open Positions
Select open positions to apply for:
Any
Buyer, Favorites Catalog
Digital Marketplace Manager
General Merchandise Manager
Contact Information
First Name
Initial
Last Name
Address
City
State
Zip Code
Phone
Email
General Information
Have you ever submitted an application to us before?
-- Select --
YES
NO
If yes, when?
If yes, enter previous application
Date
Have you ever been employed by us before?
-- Select --
YES
NO
If yes, when?
previous employment dates
If yes, enter
Start Date
Enter
End Date
Are you at least 16 years of age?
-- Select --
YES
NO
16 is our minimum age requirement. If you are under 18 years of age, you must provide a work permit upon your start date.
Are you prevented from lawfully becoming employed in this country because of VISA or Immigration Status?
-- Select --
YES
NO
Proof of legal eligibility to work in the United States will be required upon employment.
Have you ever been discharged or asked to resign from a position?
-- Select --
YES
NO
If yes, specify reason:
-- Select --
Business Closed
Job Performance
Layoff
Misconduct
Policy Violation
Other
How did you learn about us?
-- Select --
Web Site
Newspaper Ad
Employee Referral
Employment Agency
Walk-In
Job Fair
Other
Specify
additional information as applicable
:
What are your salary expectations?
What date would you be available to start employment?
Availability
What is your availability?
Select all applicable options and duration. At least one option must be selected.
Full-Time
Part-Time
Temp
-- How long? --
1 to 3 Months
3 to 6 Months
6 to 12 Months
Open
Select
Schedule Preference
Day
Evening
Select
Hours you are available to work:
Hours you are available to work
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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MIDNIGHT
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Employment History
List your present employer (if applicable) and two previous employers. You may include volunteer work which can be verified. Complete all sections as applicable.
Employer 1
Company Name
Address
City
State
Zip Code
Job Title
Brief description of your duties:
Supervisor Name, Title
Reason for Leaving
Phone
Employment Dates
dates of employment for employer 1
Start
End
Okay to contact employer?
-- Select --
YES
NO
Employer 2
Company Name
Address
City
State
Zip Code
Job Title
Brief description of your duties:
Supervisor Name, Title
Reason for Leaving
Phone
Employment Dates
dates of employment for employer 2
Start
End
Okay to contact employer?
-- Select --
YES
NO
Employer 3
Company Name
Address
City
State
Zip Code
Job Title
Brief description of your duties:
Supervisor Name, Title
Reason for Leaving
Phone
Employment Dates
dates of employment for employer 3
Start
End
Okay to contact employer?
-- Select --
YES
NO
Education
Highest level of education.
School Name
School Location (City, State)
Course of Study
Degree/Diploma
Years Completed
-- Select --
1
2
3
4
5
6
7
8
9
10
11
12
Additional Information
State your career goals, if any:
200 characters remaining.
Please advise of any skills, languages, or other unique qualifications:
200 characters remaining.
Important
By submitting this application I certify that all of the information given by me on this application and in any interview is true in all respects. I agree that if I am employed and any information is found to be false in any way, that I will be subject to dismissal without notice when discovered. I understand that employment is contingent upon satisfactory reference checks and the completion of a period of training. I further understand that employment is “at will” which means that either I or the Company can terminate the employment relationship at any time.
I hereby authorize Potpourri Group, Inc., its employees and agents, to make inquiry of and request information from, any individuals, present and former employers, school, colleges, credit bureaus, and any other entities that may possess information concerning me or that may be custodians of records relating to me. I also authorize the above described sources to release all information requested, including salary data and subjective evaluations, and I hereby release those sources from any liability for doing so. I understand that this authorization is not a condition of employment. This application will remain valid for 30 days. If you wish to be considered for employment beyond that period, you will be required to complete another employment application.
I've read and understand above information.
acknowledgement required
SUBMIT APPLICATION