GENERAL INFORMATION
Date
Position(s) Applied For (1) ________________________________________
(2) ____________________________________________________
Referral Source 0 Newspaper 0 Friend 0 Relative 0 Employment Agency 0 HigherEdJobs.com
0 Internet Search 0 Professional Journal 0 Walk-in 0Other__________
Name
Last First Middle
Address
Number Street City State Zip
Home Telephone ( )
Cell Phone ( )
E-mail address
If under 18, can you provide a work permit? 0 Yes 0 No
Have you ever filed an application here before? 0 Yes 0 No If yes, give date
Have you ever been employed here before? 0 Yes 0No If yes, give date
Are you currently employed? 0 Yes 0 No
If yes, may we contact your employer? 0 Yes 0 No
Are you a United States citizen? 0 Yes 0 No If no, do you have a valid work permit? 0 Yes 0 No
(Proof of citizenship or immigration status may be required upon employment)
Employment desired: 0 Full-Time 0 Part-Time 0 Shift Work 0 Temporary 0 Overtime
When are you available for work?
Are you on a lay-off and subject to recall? 0 Yes 0 No
Can you travel if a job requires it? 0 Yes 0 No