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Employment Info
Personal
*
Name
*
Address
*
City
*
State
*
Zip
Phone
SSN
*
Email
Date of Birth (if over 18)
Are you able to provide proof of age if hired?
yes
no
History
*
Have you ever been convicted of a felony?
yes
no
If yes, what was the felony?
What is your education history?
High School Student
High School Graduate
College Student
College Graduate
Will you work during spring break, Christmas break, Thanksgiving weekend, summer school break, and/other vacation periods?
yes
no
How many hours are you available and willing to work?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
*
If hired, when can you begin work?
Previous Employment
*
Company
*
Address
Telephone
Position
Supervisor
Dates Worked
Reason for Leaving
Company
Address
Telephone
Position
Supervisor
Dates Worked
Reason for Leaving
Do we have permission to contact your current employer?
yes
no
Certifications: Please list work experience:
Personal References (please no family members)
Name
Phone
Name
Phone
Authorization
I certify that to the best of my knowledge that this information and the statements made by me in this application are correct and complete without omission of any kind whatsoever. I understand that giving incomplete or false information, whether in this application or otherwise, may be cause for discharge at any time during employment. You are hereby authorized to investigate all the statements made in this application. I further understand that I do not have an employment contract and that my employment and compensation can be terminated with or without notice or cause at any time by the company or me.
*
I certify the above statement.