Employment Application

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Fill out this form to apply for employment.

Employment Form
Name
Address
Are you a US Citizen?
Are you applying for full time or part time?
Can you work Monday-Friday 10-6 & Saturdays, May - July? If not, when are you available to work?
Do you have a valid Driver's License?
Do you have reliable transportation to work?
Can you lift 75 pounds?
Have you had a serious injury or illness in the past five years?
Have you ever received compensation for injuries?
Have you ever been convicted of a felony or do you have any felonies?

US Military Record


Education


High School Diploma/Degree Received?
College/University Degree Received?
Graduate School Degree Received?
Vocational School Degree Received?

Employment History


Begin with current or most recent employer. Do not exclude any employment. Include any applicable temporary employment. Enter any additional employment information in the box at the end of this section. Previous salaries or wages will not be used to determine compensation.

Previous Employer References


Emergency Contact Information


Clear Signature

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