Application For Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or other legally protected status.
Position(s) Applied For : Cashier    Manager
Last Name :      First Name :      Middle Initial :
Address Line 1 :      Address Line 2 :
City :      State :      Zip Code :
Phone :
Have you ever filed an application with us? : Yes    No
Have you ever been employed with us? : Yes    No
Are you currently employed? : Yes    No
Are you prevented from lawfully becoming employed in this country because of Visa or Imigration Status?
    (Proof of citizenship or immigration will be required upon employment : 		Yes    No
On what date would you be available to work? :   
Are you available to work? : Full Time    Part Time    Temporary
Have you been convicted of felony within last 7 years?
    (Conviction will not necessarily disqualify an applicant from employment) 		Yes    No
If yes, please explain
Highest Education :
Other Education :
Other Education :
Recent Employment :
Employer :
Address Line 1 :      Address Line 2 :
City :      State :      Zip Code :
Phone :
Supervisor :      Position Title :
From Date :       To Date :      
Responsibilities :      Salary :
Reason for leaving :      May we contact :
Previous Employment :
Employer :
Address Line 1 :      Address Line 2 :
City :      State :      Zip Code :
Phone :
Supervisor :      Position Title :
From Date :       To Date :      
Responsibilities :      Salary :
Reason for leaving :      May we contact :
Previous Employment :
Employer :
Address Line 1 :      Address Line 2 :
City :      State :      Zip Code :
Phone :
Supervisor :      Position Title :
From Date :       To Date :      
Responsibilities :      Salary :
Reason for leaving :      May we contact :