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Home > Employment Application Please fill out everything completely. If something does not apply, leave blank PERSONAL INFORMATION First Name: Middle Name: Last Name: Street: Street 2: City: State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP/Postal Code: Email Address: Phone Number: Are you at least 18 years old?: Yes No Are you legally eligible to work in the United States?: Yes No Have you ever been convicted of a crime?: No Yes, A Misdemeanor Yes, A Felony Are you able to stand for up to 8 hours during a shift?: No Yes Are you able to lift up to 70 pounds repetitively?: No Yes We have a strict "no cell phone usage" policy. Cell phones can only be used during breaks and not allowed in work areas. Will you be able to adhere to our strict NO CELL PHONE policy?: No Yes Do you have reliable transportation?: No Yes Do you have a valid drivers license?: No Yes What is your expected hourly pay?: Please tell us about yourself, in your words, tell us why you would be a great addition to our team: Please select your employment preference: Temporary Part Time Full Time How many days per week are you available to work?: 1 day per week 2 days per week 3 days per week 4 days per week 5 days per week 6 days per week 7 days per week When is the earliest you can start working?: Immediately In 1 week In 2 weeks In 3 weeks In 4 weeks Longer than 4 weeks HIGH SCHOOL EDUCATION Select the highest middle or high school grade level you have completed: 9th grade 10th grade 11th grade 12th grade Do you have a high school diploma or GED?: No Yes High School Name: High School City: High School State: TRADE SCHOOL EDUCATION Select the number of years you have completed: 0 years 1 year 2 years 3 or more years Did you earn a certificate?: No Yes Trade School Name: Trade School City: Trade School State: COLLEGE EDUCATION Select the number of years you have completed: 0 years 1 year 2 years 3 or more years Select the degree earned: none Associates Bachelors Masters College Name: College City: College State: EMPLOYMENT HISTORY 1 (most recent first) Name Of Employer: Employer Address: Employer Phone Number: Job Title: Job Description/Duties: Start Date: End Date: Starting Hourly Salary: Ending Hourly Salary: Supervisor Name: Reason For Leaving: Still Employed Terminated Voluntary Leave Assignment Ended May We Contact This Employer?: Yes No EMPLOYMENT HISTORY 2 Name Of Employer: Employer Address: Employer Phone Number: Job Title: Job Description/Duties: Start Date: End Date: Starting Hourly Salary: Ending Hourly Salary: Supervisor Name: Reason For Leaving: Still Employed Terminated Voluntary Leave Assignment Ended May We Contact This Employer? 2: Yes No EMPLOYMENT HISTORY 3 Name Of Employer: Employer Address: Employer Phone Number: Job Title: Job Description/Duties: Start Date: End Date: Starting Hourly Salary: Ending Hourly Salary: Supervisor Name: Reason For Leaving: Still Employed Terminated Voluntary Leave Assignment Ended May We Contact This Employer?: Yes No EMPLOYMENT HISTORY 4 Name Of Employer: Employer Address: Employer Phone Number: Job Title: Job Description/Duties: Start Date: End Date: Starting Hourly Salary: Ending Hourly Salary: Supervisor Name: Reason For Leaving: Still Employed Terminated Voluntary Leave Assignment Ended May We Contact This Employer?: Yes No PERSONAL REFERENCE 1 Name: Phone Number: Relationship: Years Acquainted: City: State: May We Contact This Reference?: Yes No PERSONAL REFERENCE 2 Name: Phone Number: Relationship: Years Acquainted: City: State: May We Contact This Reference?: Yes No PERSONAL REFERENCE 3 Name: Phone Number: Relationship: Years Acquainted: City: State: May We Contact This Reference?: Yes No Please include any experience or other relevant information that may help us consider you for this position: Enter the following code (not case sensitive):