Employment Application

Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Regular full-time work? *

Yes

No

Regular part-time work? *

Yes

No

Temporary work? *

e.g. summer or holiday

Yes

No

If applying for temporary work, during what period of time will you be available?

From:

MM

DD

YYYY

To:

MM

DD

YYYY

Are you available for work on weekends? *

Yes

No

Would you be available to work overtime, if necessary? *

Yes

No

If hired, on what date can you start work? *

MM

DD

YYYY

Would you be willing to relocate to the location (City & State) of this open position? *

Yes

No

N/A - I already live locally and can commute easily!

Are you legally authorized to work in the United States on a full-time basis? *

Yes

No

Will you now or in the future require sponsorship for employment visa status? *

Yes

No

Applicant Name

First Name

Last Name

Date

MM

DD

YYYY

Gender

Male

Female

Ethnicity

Hispanic or Latino

White (Not Hispanic or Latino)

Black or African American (Not Hispanic or Latino)

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

Asian (Not Hispanic or Latino)

American Indian or Alaska Native (Not Hispanic or Latino)

Two or more races (Not Hispanic or Latino)

Veteran Status

Vietnam-Era Veteran

Other Veteran

Not a Veteran

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