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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:

ZIP/Postal Code:

Email Address:

Phone Number:

Are you at least 18 years old?:

Are you legally eligible to work in the United States?:

Have you ever been convicted of a crime?:

Are you able to stand for up to 8 hours during a shift?:

Are you able to lift up to 70 pounds repetitively?:

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?:

Do you have reliable transportation?:

Do you have a valid drivers license?:

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:

How many days per week are you available to work?:

When is the earliest you can start working?:




HIGH SCHOOL EDUCATION



Select the highest middle or high school grade level you have completed:

Do you have a high school diploma or GED?:



High School Name:

High School City:

High School State:




TRADE SCHOOL EDUCATION



Select the number of years you have completed:

Did you earn a certificate?:



Trade School Name:

Trade School City:

Trade School State:




COLLEGE EDUCATION



Select the number of years you have completed:

Select the degree earned:



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:

May We Contact This Employer?:




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:

May We Contact This Employer? 2:




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:

May We Contact This Employer?:




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:

May We Contact This Employer?:




PERSONAL REFERENCE 1



Name:

Phone Number:

Relationship:

Years Acquainted:

City:

State:

May We Contact This Reference?:




PERSONAL REFERENCE 2



Name:

Phone Number:

Relationship:

Years Acquainted:

City:

State:

May We Contact This Reference?:




PERSONAL REFERENCE 3



Name:

Phone Number:

Relationship:

Years Acquainted:

City:

State:

May We Contact This Reference?:



Please include any experience or other relevant information that may help us consider you for this position:



Enter the following code (not case sensitive):