Date of Birth
(valid email required)
Driver's License #
Do you have your own dependable transportation?
If you are under 18, can you furnish a work permit?
Date you can start:
Are you employed now?
May we contact your current employer?
Salary or wages desired?
Hours per week you would like to work?
Days and hours you could work:
Morning Shift (Days and Hours)
Afternoon Shift (Days and Hours)
Evening Shift (Days and Hours)
Overnight Shift (Days and Hours)
Have you ever been convicted of any crime or misdemeanor other than a parking violation?
If “yes” please explain including date, charge and disposition (failure to do so could be grounds for immediate dismissal).
Do you consent to a criminal background check? (Conviction record will not necessarily bar employment)
How did you hear about the opening?
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