APPLICATION FOR EMPLOYMENT

PLEASE PRINT ALL INFORMATION REQUESTED

EXCEPT SIGNATURE

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

Date ________________________________

Name__________________________________________________

Present address _________________________________________

Telephone _____ – _________

Birthdate ____-______-_______

Position applied for ________________________

Salary desired ________________________

(Be specific)

Days/hours available to work

Mon _________________________ Fri _______________________

Tue _________________________ Sat _______________________

Wed _________________________ Sun ______________________

Thur _________________________

How many hours can you work weekly? _______________________ Can you work nights? _______________________

Employment desired                  FULL-TIME                      PART-TIME

Date available for work?_______________

HAVE YOU EVER BEEN CONVICTED OF A CRIME? __ No __ Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were

committed, sentence(s) imposed, and type(s) of rehabilitation. __________________________________________________

____________________________________________________________________________________________________

DO YOU HAVE A DRIVER’S LICENSE? __ Yes __ No

What is your means of transportation to work? _______________________________________________________