Employment Application

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Will you accept employment of:

Full Time

Part Time

Temporary

Date Available

MM

DD

YYYY

If under 18, do you have a work permit?

Yes

No

N/A

Did you Graduate?

Yes

No

Did you Graduate?

Yes

No

May We Contact for Reference?

Yes

No

May We Contact for Reference?

Yes

No

May We Contact for Reference?

Yes

No

May We Contact for Reference?

Yes

No

May We Contact for Reference?

Yes

No

Will You Accept Another Position?

Yes

No

Weekends

Yes

No

Rotating Shifts

Yes

No

Holidays

Yes

Option Two

I Understand That Emergency Conditions May Require Me to Temporarily Work Shifts Other Than the One for Which I am Applying and Agree to Such Scheduling Change as Directed by My Department Manager or Administrator of This Institution.

Yes

No

I have fully read, understand and agree with the terms detailed above: *

Yes

No