Virginia Application

Your Full Name *

E-mail Address *

Cell Phone Number *

Address *

City *

State *

Zip Code *

High School Attended

Year you graduated from High School

College

Area Studied

Did you graduate from college?

Yes

No

Please list below any other education you may have from trade schools, business schools, etc. Also, you may list any special training, skills or trades you may possess

Previous Employer

Phone Number

Supervisor

Position

Below describe your responsibilities and duties

Salary

Reason For Leaving

May we contact your employer for reference?

Yes

No

Previous Employer #2

Phone Number

Supervisor

Position

Below describe your responsibilities and duties

Salary

Reason For Leaving

May we contact your employer for reference?

Yes

No

Use the space below to tell us about yourself, achievements or any experiences that may make you an excellent candidate for our organization. You may also paste your resume.

Have you ever been convicted of any crime other than a minor traffic violation?

Yes

No

If yes, explain

Have you ever worked in retail sales?

Yes

No

If yes, explain

Can you pass a routine background check? *

Yes

No

Do you have the legal right and necessary papers to work and live in the United States? *

Yes

No

Where did you hear of Tri-State Fireworks?

Additional Comments

I certify the above information to be true and accurate to the best of my knowledge. Furthermore, I understand any false statements or failure to disclose information may be grounds to disqualify me for employment. The information I have submitted is subject to verification by a complete background check, criminal record check, and employment verification. *

By checking this box, I sign this application and agree with the above statement.

I do not confirm acknowledgement of the statement above.