Employment Application
Name: _____________________________ Social Security #: _______________
Date of Birth: _______________________ Driver’s License: ________________
Address: __________________________ Years at address: _______________
City, State, Zip: __________________ Phone Number: _________________
Email: __________________________ Position applied for: _________________
Salary desired: ___________ Are you vaccinated or plan to get vaccinated?______
How were you referred? ______________________________________________
Do you have your own car/ transportation? _______________________________
If not, how will you get to work? _______________________________________
Are you a legal citizen of the U.S.? ______________________________________
States you have resided in the last 10 years: ______________________________
Availability:
What date are you able to start? ________________________________________
Are you willing to work any shift, including evenings and weekends? ____________
(Mandatory 2 weekends per month) (Holidays are rotated and mandatory)
State any shift limitations you may have: _________________________________