APPLICATION FOR EMPLOYMENT          DATE___________________             

Personal Information:

Name:______________________________________ Social Security#_____-_____-______

Address:_______________________________City_________________ST_____Zip________

Home Phone______________________________
Cell Phone _______________________________

Employment Desired:  Position: ___Part Time Helper         Date you can start_____________      
Are you currently employed? Y____ N____ 
If so, may we inquire of your present employer? Y____ N___
Ever applied to this company before? Y___ N___   
Where?________________ When? ____________

Education:
Name & Location of School                                                          Years Attended   

Grammer:

Middle:

High School:

General:  Special training or studies/research work/special skills:

Personal References:  Give 3 names of persons not related to you, whom you have
known at least one year.

NAME                                                                                      PHONE      YEARS KNOWN

Authorization:

"I certify that the facts contained in this application are true and complete to the best of my knowledge
and understand that, if employed, falsified statements on this application shall be grounds for dismissal. 

I authorize investigation of all statements contained herein and the references and employers listed above
to give you any and all information concerning my previous employment and any pertinent information they
may have, personal or otherwise, and release the company from all liability for any damage that may result
from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any
agreement for employment for any specified period of time, or to make any agreement contrary to the
foregoing, unless it is in writing and signed by an authorized company representative. "

Date______________________ Signature ____________________________________________

Email: ________________________________________________________