Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Preferred method of contact *

Phone

Text

Email

Are you 16-years old or older? *

Yes

No

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? *

Yes

No

Have you been convicted of or pleaded no contest to a felony within the past five years? *

Yes

No

If hired, are you willing to submit to a controlled substance test? *

Yes

No

Position applying for *

Cashier

Cook

Any

Type of employment desired *

Full-time

Part-time

Days available to work *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Date available to start *

MM

DD

YYYY

Did you graduate?

Yes

No

Are you currently employed? *

Yes

No

If you are currently employed, may we contact your current employer?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####