Referral Source (select one):Advertisement  Friend Relative Walk-in Employment Agency Other

Address:

If employed and you are under the age of 18 can you furnish a work permit? Yes No

Have you ever filed an application before? Yes No

Have you ever been employed here before?  Yes No

Are you employed now? Yes No    May we contact your present employer? Yes No

If hired can you furnish proof you are legally entitled to work in the United States? Yes No

On what date would you be available to work?

You will be available to work: FULL TIME  PART-TIME  SHIFT WORK  TEMPORARY

Can you travel if a job requires it?  Yes  No

Have you been convicted of a felony within the past 7 years?  Yes  No

If yes, please explain.

(Conviction will not necessarily disqualify applicant from employment)

Personal References

List name, address, and telephone number of three references who are not related to you and are not previous employers

Name: Address: Phone:

Name: Address: Phone:

Name: Address: Phone:

Describe specialized training, apprenticeships, skills, and extra curricular activities, honors received

State any additional information you feel may be helpful to us in considering your application

Summarize special skills and qualifications acquired from employment or other experience such as specific office skills, machines used, etc.

Employment History

Applicant’s Statement

I understand this application is considered current for 90 days.  If I want to be considered for employment after that time,  I must renew my application in writing.

I certify that answers given herein are true and complete to the best of my knowledge

I authorize investigation of all statement contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and in not intended to be a contract of employment.  I further understand said background check may also involve the Company’s obtaining an investigative consumer report on me, which may cover such areas as my character and general reputation.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the Company.