City ST Zip
Date you can start work
Current employer phone #
List your past 3 employers, beginning with most recent:
List the past 3 schools you attended, beginning with the most recent.
Name Years Completed Did you graduate? Major/Degree
List any special skills/abilities you have that can be applied to this position.
Have you ever been convicted of a felony within the past 5 yrs? If yes, explain:
Do you have a valid driver's license & vehicle?
Do you have a lift weight restriction ?
Are you willing to take a drug test ?
Are you available to work Saturdays ?
By completing this form you certify that the facts contained in this application are true and complete to the best of your knowledge and understand that if employed, falsified statements on this application will be grounds for dismissal.
EQUAL OPPORTUNITY EMPLOYER
Mon through Fri 8 am - 5 pm
Sat. 8 am-Noon