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Employment Application

Select the Location You're Applying To*
Your Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Email*
- Phone*
- Are you under 18?*
  - Yes
  - No
- Date of Birth*
  Date Format: MM slash DD slash YYYY
Education
High School*
Name of School Last Grade Completed Grade Point Average Sport/Activities Degree Date Graduated
College
Name of School Last Grade Completed Grade Point Average Sport/Activities Degree Date Graduated
Work Experience
List most recent first
Do you have any previous work experience?*
- I’m looking for my 1st job
- Yes
How many previous companies?
Company 1
- Company Name*
- Phone*
- Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Dates Employed*
  To From
- Job Description*
- Supervisor Name
  First Last
- Reason for Leaving
- Ending Pay
Company 2
- Company Name*
- Phone*
- Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Dates Employed*
  To From
- Job Description*
- Supervisor Name
  First Last
- Reason for Leaving
- Ending Pay
Company 3
- Company Name*
- Phone*
- Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Dates Employed*
  To From
- Job Description*
- Supervisor Name
  First Last
- Ending Pay
- Reason for Leaving
What school activities or community involvement are you most proud of?*
Personal References
List References*
Name Phone Years Known
Availability
Date you can start
Date Format: MM slash DD slash YYYY
Days and Times for Availablity
Day of the Week Start Time End Time
How many hours would you like to work each week?*
Holidays you are available to work*
- Easter
- Mother’s Day
- Memorial Day
- Father’s Day
- Independence Day
- Labor Day
How were you referred to us?
Do you have transportation to work?*
Do you have any physical limitations that would prevent you from doing this type of work?*
Have you ever been convicted of a crime?*
- Yes
- No
Please list offense and dates:
Please rate yourself honestly on the following characteristics or scenarios.

*

	Never	Rarely	Sometimes	Often	Always
I am late for scheduled appointments
When working in groups, I take on more than my share.
I ask for help when needed.
As a customer, my expectations should be exceeded.
I feel successful.

I certify that I have read and fully completed this application and the information contained within this application is correct to the best of my knowledge. I also understand that any false information is grounds for dismissal.
- Signature*
- Date*
  Date Format: MM slash DD slash YYYY

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