Employment Application Form

Full-Part-Temp Full TimePart TimeTemp Seasonal

Can you perform the essential functions of the position for which you are applying, with or without reasonable accommodation? YesNo

If no, please explain: if you have any questions as to what functions are applicable to the position for which you are applying, please ask the interviewer before you answer this question):

Are you legally eligible to be employed in the United States?

Proof of identity & eligibility will be required upon employment

YesNo

Are you over the age of 18 years?

If no, you may be required to provide authorization to work

YesNo

How did you hear about us?

If an advertisement, name of outlet:

If a referral, name of referring employee:

Days & hours available:

Are you presently employed? YesNo

If yes, may we contact your employer? YesNo

If presently employed, why are you considering leaving?

Do you belong to any professional, trade, business or civic organizations that deal with the position for which you are applying? YesNo

If yes, please explain & list:

(Omit any organization which reflects your race, color, religion, age, sex, sexual orientation, marital status, or disabilities)

Have you completed any special courses, seminars, &/or training that would enable you to perform the position for which you are applying? YesNo

If yes, please describe:

List academic honors, extracurricular activities, offices held, etc in high school or college:

(Omit any organization which reflects your race, color, religion, age, sex, sexual orientation, marital status, or disabilities)

Personal

Days & hours available:

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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