Employment Application

Last Name *

First Name *

Middle Inital *

Street Address *

City *

State *

ZIP *

Date of Birth *

Phone *

Email *

Parent Email

Student Email

Date Available to Begin Work*

Days/hours available to work: *
MondayTuesdayWednesdayThursdayFridaySaturdayNo Preference

School History

High School:

High School Name

City

State

Years Completed

College:

College Name

City

State

Years Completed

Major/Degree

Business/Trade School:

School Name:

City

State

Years Completed

Major/Degree

Professional School:

Professional School Name

City

State

Years Completed

Major/Degree

Personal Information

What is your means of transportation to work? *

Do you have a driver's License? *
NoYes

Driver's License Number*

Driver's License State*

Driver's License Expiration Date*

License Type*
OperatorCommercial (CDL)Chauffer

How many accidents have you had during the past three years?*

How many moving violations have you had during the past three years?*

Have you been convicted of a crime?
NoYes

If yes, please explain number of convictions, nature of offense(s), how recently offense(s) were committed, sentence imposed, and
type of rehabilitation.

Work History

Employer 1

Employer Name

Employer Full Street Address

Employer City

Employer State

Employer ZIP

Supervisor Name

Employment Start Date

Employment End Date

List of duties performed, skills learned, or advancements during employment

Reason for Leaving

Employer 2

Employer Name

Employer Full Street Address

Employer City

Employer State

Employer ZIP

Supervisor Name

Employment Start Date

Employment End Date

List of duties performed, skills learned, or advancements during employment

Reason for Leaving

References

(List two references OTHER THAN relatives or previous employers)

Reference 1

Name

Relationship

Job Title

Phone

Reference 2

Name

Relationship

Job Title

Phone

All the information given on this application is true to the best of my knowledge.

Applicant's Signature*

Date of Application*