Name *

First Name

Last Name

Phone Number *

(###)

###

####

Are you at least 18 years old? *

Yes

No

If hired, can you present proof of your legal right to work in the United States? *

Yes

No

Which types of shifts are you willing to work? *

Check all that apply.

Part-Time

Full-Time

Morning

Evening

Anytime

Which days are you available to work? *

Check all days you are available.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

When are you available to start working for us? *

MM

DD

YYYY

Are you able to perform the essential functions of this job with or without reasonable accommodation? *

Yes

No

Previous Supervisor's Name *

Please list the name of one previous supervisor.

First Name

Last Name

Previous Supervisor's Phone *

(###)

###

####

Do we have your permission to directly contact this reference? *

Yes

No

Before submitting your application, please read the statement below and check the box if you agree to it. *

I hereby authorize the Company to contact, obtain and verify the accuracy of information contained in this application from all previous employers, educational institutions and references. I also hereby release from liability the Company and its representatives for seeking, gathering and using such information to make employment decisions. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment, whenever it may be discovered. If I am employed, I acknowledge that there is no specific length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the Company can terminate the relationship at will, with or without cause or notice at any time.

I agree