Name *

First Name

Last Name

Phone *

(###)

###

####

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) *

Yes

No

Are you 18 years or older? *

Yes

No

Are you looking for full-time employment? *

Yes

No

What is your shift preference? *

1st

2nd

Are you willing to work overtime? *

Yes

No

Do you have any obligations that would keep you from having regular and predictable attendance? *

Yes

No

Have you missed any work or school in the past year? *

Yes

No

Do you have any physical limitations that would impair your performance on the job applied for? *

Yes

No

Have you ever been convicted of a crime other than minor traffic violations? *

Yes

No

Have you ever applied for employment here or worked here through an agency? *

Yes

No

Have you ever been employed by this company? *

Yes

No

Do you have any friends or relatives that work here?

Yes

No

Are you presently employed? *

Yes

No

May we contact your present employer? *

Yes

No

Will you relocate? *

Yes

No

Are you willing to travel? *

Yes

No

Date you can start

MM

DD

YYYY

Did you graduate?

Yes

No

Were/are you in Military service? *

Yes

No