Fields marked with ( * ) are required. If the fields do not apply, please fill in with N/A.
Date*
First Name*
Last Name*
Your Email*
Phone* (ex: 817-555-0000)
Current Address*
Position(s) Applying For*
Temporary Work (such as summer or holiday work)?*
YesNo
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?*
YesNo Salary Desired*
Have you ever applied to / worked for Company before? *
YesNo If so, please explain (include date)*
Do you have any friends, relatives, or acquaintances working for Company?*
YesNo 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?*
School Name*
Did you graduate?*
YesNo Degree/Diploma Earned*
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* Phone Number* Length of Employment (Include Dates):* Position & Duties:* Reason for Leaving*
May we contact this employer for references?*
YesNo Upload Resume
Electronic Signature*
