AN EQUAL OPPORTUNITY EMPLOYER: We do not discriminate on the basis of race, religion, national origin, color, sex, age, marital status or disability.

 

General Information:                                                               Date: ____/____/20____

Last Name: _____________________ First Name: ____________________ Middle Name: _______________

Street Address (including City State and Zip): ________________________________________________________

Mailing Address (including City State and Zip): ______________________________________________________

Phone Number:(______)______-__________                            18 or older? Yes____ No ____

Do you have reliable transportation? Yes____ No ____

Do you have a driver’s license? Yes____ No ____

Have you had your license revoked in the last three years? Yes____ No ____

Have you ever been convicted of a felony or violation of law that affected previous employment? Yes__ No __

If yes, please give details: ____________________________________________________________________________________________________________________________________________________________________________________

Employment Desired:

Position Applying For: ____________________________________________

Part-Time ____ Full-Time ____ Date Available to start: ___________ Wage Desired: __________

Have you ever applied to the Company before? Yes ___ No ___ If Yes, When? _______________

Please circle one of the following choices:

  1. I am a returning employee and would like to work at ________________ again.
  2. I am a returning employee; previously I worked at ___________ but would like to work at _________.
  3. I am a new applicant and would like to work at: _____________ or ______________.

Are you available to work Evenings, Weekends, and Holidays?  Yes _____ No _______

Do you have a legal right to Work in the United States? Yes _____ No _______

Note: All employees will be required to submit proof of their eligibility to work in the United States.

If you are under 18, you are required to furnish a New York State work permit obtained from any New York State school.

 

Availability

 

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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Education:

School Name    Years Attended            Did you graduate?            Degree                                  GPA   

High School: _____________   9  10  11  12                        Yes            No                   __________________  ________

College: ________________   1    2    3    4                        Yes            No                   __________________  ________

U.S. Military: _______________________  Branch: _____________________________________________

Special Training received: __________________________________________________________________

Are you currently enrolled in High School ________________ College ______________ Other ___________

If so, give name and address of school _________________________________________________________