EMPLOYMENT APPLICATION

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Emergency Contact Name*
First Last
Emergency Contact Phone*
Are you 18 years of age or older?*
Are you 16 years of age or older?*
If no, can you provide a work permit?*
If hired, can you provide written evidence that you are authorized to work in the U.S.?*
EDUCATION
Add High School?
High School
School Name
Course of Study
Years Completed
Degree/Diploma
Add College?
College
School Name
Course of Study
Years Completed
Degree/Diploma
Add Technical School or Other?
Technical or Other
School Name
Course of Study
Years Completed
Degree/Diploma
EMPLOYMENT RECORD
Add Employment Experience?
Experience #1
Company Name
Position
Date Started
Date Left
Pay Rate
Reason for Leaving
Contact Person Name
First Last
Contact Person Phone
Add a 2nd Employment Experience?
Experience #2
Company Name
Position
Date Started
Date Left
Pay Rate
Reason for Leaving
Contact Person Name
First Last
Contact Person Phone
Add a 3rd Employment Experience?
Experience #3
Company Name
Position
Date Started
Date Left
Pay Rate
Reason for Leaving
Contact Person Name
First Last
Contact Person Phone
MILITARY EXPERIENCE
Add Military Experience?
Branch of Service
Date Started
Date Left
Rank and Type of Service
REFERENCES
We require 4 references. Do not include relatives. Include teachers, coaches, church leadership or previous employers.
Reference #1
Name*
First Last
Occupation*
Years Known*
Phone*
Reference #2
Name*
First Last
Occupation*
Years Known*
Phone*
Reference #3
Name*
First Last
Occupation*
Years Known*
Phone*
Reference #4
Name*
First Last
Occupation*
Years Known*
Phone*
EMPLOYMENT
Type of work desired:*
Salary desired:*
Date you can start:*
Number of hours you wish to work each week:*
Have you ever been warned, disciplined or discharged for sexual harassment, fighting, assault or attendance?*
Explain below:*
Please list any miscellaneous experience that may help you succeed in the job you are seeking:
AVAILABILITY
To be considered for most positions you must be available to work weekends (Friday, Saturday, and Sunday). Please use time options from 12:00am to 12:00pm in 30 minute increments.
Monday From:*
Monday To:*
Tuesday From:*
Tuesday To:*
Wednesday From:*
Wednesday To:*
Thursday From:*
Thursday To:*
Friday From:*
Friday To:*
Saturday From:*
Saturday To:*
Sunday From:*
Sunday To:*

EMPLOYMENT APPLICATION

EDUCATION

High School

College

Technical or Other

EMPLOYMENT RECORD

Experience #1

Experience #2

Experience #3

MILITARY EXPERIENCE

REFERENCES

Reference #1

Reference #2

Reference #3

Reference #4

EMPLOYMENT

AVAILABILITY