Job Application

Please list the days and times you are available to work

Give the names of three persons you have worked with; paid or unpaid, for at least (1) year.

In the following 3 boxes please list your work experience.

• Dates from – to:
• Employer Name:
• Employer Phone:
• Employer Address:
• Job Title:
• Supervisor:
• Reason for leaving:
• Pay rate:

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND I MAY, AT THE DISCRETION OF THE EMPLOYER, BE TERMINATED AT ANY TIME WITHOUT ANY PREVIOUS NOTICE.