applymaggiebj2013-05-23T20:08:34+00:00 PERSONAL INFORMATION First Name* Last Name* Permanent Address* guniyr City* State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code* Telephone* Email Address* Are you legally eligible to work in the United States?* yesno Have you ever been convicted of a felony?* yesno If yes, please explain: Is there anything that would prevent you from performing the functions of this position with or without reasonable accommodations?* yesno If yes, please explain: AVAILABILITY Days Available: MondayTuesdayWednesdayThursdayFridaySaturdaySunday Hours per week desired: What date are you available to start working? (mm/dd/yyyy) Additional comments regarding availability and schedule limitations: SKILLS Check those that apply: Basic computer operationCash register operationFluency in foreign language Are there any other experiences, skills, or abilities that you feel qualify you to work here? This is the most important part of your application! EDUCATION I am currently enrolled in: high schoolcollegenoneother High School* (name and location): Graduated? yesno College (name and location): Graduated? yesno Other (name and location): Graduated? yesno Additional comments regarding education: EMPLOYMENT HISTORY Company 1 (name and location): Job Description: Supervisor: Supervisor's Phone: Permission to contact? yesno Start: (mm/yyyy) End: Reason for leaving: Company 2 (name and location): Job Description: Supervisor: Supervisor's Phone: Permission to contact? yesno Start: (mm/yyyy) End: Reason for leaving: Company 3 (name and location): Job Description: Supervisor: Supervisor's Phone: Permission to contact? yesno Start: (mm/yyyy) End: Reason for leaving: Company 4 (name and location): Job Description: Supervisor: Supervisor's Phone: Permission to contact? yesno Start: (mm/yyyy) End: Reason for leaving: REFERENCES Name Relationship Telephone Name Relationship Telephone Name Relationship Telephone ADDITIONAL INFORMATION Salary Expected: This company is an equal opportunity employer and will not discriminate, or tolerate discrimination, against any employee or applicant in any manner prohibited by law. I certify that the information on this application is true and complete to the best of my knowledge. I understand that any false information on this application shall be grounds for dismissal. I authorize investigation of all information contained on this application. I give permission to the references and employers listed to provide any information they may have, personal or otherwise, and release all parties from any liability or damages that may result from such information. I understand that no representative of the company has the authority to enter into any agreement for employment for any specified period of time or to make any agreement unless it is in writing and signed by the owner of the company. e-signature:* Please wait until you see the success message below before you close this page.