Fields marked with ( * ) are required. If the fields do not apply, please fill in with N/A.
Date* (Example: 05/05/1995).
Phone* (ex: 817-555-0000)
Position(s) Applying For*
Temporary Work (such as summer or holiday work)?*
Regular part-time work?*
Regular full-time work*
What days and hours are you available for work? *
If applying for temporary work, when will you be available?
If hired, on what date can you start working?*
Can you work on the weekends?*
Can you work evenings?*
Have you ever applied to / worked for Company before? *
If so, please explain (include date)*
Do you have any friends, relatives, or acquaintances working for Company?*
If yes, provide name & relationship:
If hired, would you have transportation to/from work?*
Are you over the age of 18? (If under 18, hire is subject to verification of minimum legal age.)*
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?*
Have you ever been convicted of a felony? Check yes or no.*
If so, when?
Did you graduate?*
Are you currently employed?*
If you are currently employed, may we contact your current employer?*
Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. Even if you have attached a resume, this section must be completed.
Name of Employer*
Name of Supervisor*
Length of Employment (Include Dates):*
Position & Duties:*
Reason for Leaving*
May we contact this employer for references?*
Electronic Signature* Enter your first and last name.
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