Position Applied for:

Date:

First Name:

Middle Name:

Last Name:

Street:

City:

State:            Zip:       

Telephone Number:

Mobile Number:

E-mail Address:

Have you ever worked for us before?

Yes No

If yes, give dates and position:

If hired, do you have a reliable means of transportation to and from work?

Yes No

Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)

Yes No

Can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?

Yes No

If hired, on what date can you start work?

What is your desired hourly salary range?

Type of employment desired:

Full-Time Part-Time Temporary Seasonal

What days are you available for work?

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

If applying for temporary work, during what period of time will you be available?

From:

To:

Are you available for work on weekends?

Yes No

Would you be available to work overtime, if necessary?

Yes No

Do you have other experience, training, or skills which you feel make you especially suited for work at with us?

Yes No

If so, please explain:

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.)

Yes No

If yes, state nature of the crime(s), when and where convicted

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date, and the surrounding circumstances, and the relevance to the position applied for, however, may be considered)

High School Name:

High School Location:

Number Of Years Completed:

Major & Degree:

College Name:

College Location:

Number Of Years Completed:

Major & Degree:

Bus/Trade School Name:

Bus/Trade School Location:

Number Of Years Completed:

Major & Degree:

Name of Employer:

Telephone No.

From:            To:       

Type of Business:

Your Supervisor’s Name

Address:

City

State:

Zip

Hourly Salary

Commission/Bonus/Compensation:

Name of Employer:

Telephone No.

From:            To:       

Type of Business:

Your Supervisor’s Name

Address:

City

State:

Zip

Hourly Salary

Commission/Bonus/Compensation:

Name of Employer:

Telephone No.

From:            To:       

Type of Business:

Your Supervisor’s Name

Address:

City

State:

Zip

Hourly Salary

Commission/Bonus/Compensation:

First Name:

Last Name:

Telephone Number:

Street:

City:

State:            Zip:       

Occupation:

No. of Years Acquainted:

First Name:

Last Name:

Telephone Number:

Street:

City:

State:            Zip:       

Occupation:

No. of Years Acquainted:

First Name:

Last Name:

Telephone Number:

Street:

City:

State:            Zip:       

Occupation:

No. of Years Acquainted: