Application for Employment What position are you interested in? * First Name *Last Name * E-mail * Phone * Address * Referred by?Desired Wage? * Are you 16 or older? *YESNOAre you 18 or older? *YESNO What date can you start? * What days are you available for work?* MONDAYTUESDAYWEDNESDAYTHURSDAYFRIDAYSATURDAYSUNDAY Do you have commitments to another employer that might affect your employment with us? If so, explain. Have you ever been convicted of a crime, other than a traffic offense? If so, explain.* Are there any positions or job duties which you cannot perform because of physical, mental, or medical handicap? If so, explain. Educational History Name of High School *Average Grades *Did you graduate?*YESNO Name of CollegeAverage GradesDid you graduate?YESNO Do you have any special training? If so, explain. Former Employers Former Employer(1)* Name of Employer *Name of Business * Address of Business* Dates worked?* Wage *Position * Reason for leaving? * Former Employer(2) Name of EmployerName of Business Address of Business Dates worked? Wage Position Reason for leaving? Former Employer(3) Name of Employer Name of Business Address of Business Dates worked? Wage Position Reason for leaving? References Give the names of three persons that you are not related to and that you've known for at least one year. Reference (1)* Reference (2)* Reference (3)* Emergency Contact In case of emergency please notify the following person: Emergency Contact* First Name *Last Name * Phone * Address * Please leave this field empty. Please answer the question below. It is our SPAM filter. * Which number is larger 5 or 10?