First Name (required)
Middle Initial
Last Name (required)
Street Address (required)
City (required)
State (required)
Zip (required)
Phone Number (required)
Email Address (required)
If you are related to any of our employees, please state the name of the employee and the employee's position, if known.
Are you lawfully authorized to work in the United States? (required) Yes No
Are you at least 18 years of age? (required) Yes No
Desired Wage
When will you be available for work (please indicate your first and last day available to work, if known)? (required)
Do you have any commitments that will require you to be absent from work during regular work hours for more than three consecutive days from May through August? (required) Yes No
If "YES" please explain
Why are you interested in seasonal employment? (required)
Company Name (required)
Company Address (City and State) (required)
Phone # (required)
Start Date (Mo/Yr) to End Date (Mo/Yr) (required)
Position (required)
Duties (required)
Reason for Leaving (required)
Can we talk to your current employer now, or only if you are hired? (required) Yes Only if Hired
Company Name
Company Address (City and State)
Start Date (Mo/Yr) to End Date (Mo/Yr)
Position
Duties
Reason for Leaving
Can we contact this employer? Yes No
Have you ever been employed by us before? (required) Yes No
If "YES" please state the positions held, period of employment and reason for leaving.
Do you meet the experience qualifications of the position? (required) Yes No
If "NO" what qualifications do you lack?
I have reviewed the essential job functions and state that I can perform these functions with or without reasonable accommodation. (required) Yes No
Have you ever been fired from a job or quit under threat of being fired? (required) Yes No
If "YES" when and who was the employer?
What reason did the employer give you for your dismissal or forced resignation?
Within the past 60 days, have you used marijuana, cocaine, any narcotics, amphetamines, barbiturates, or other controlled substances that were not taken as prescribed to you by a physician? Yes No
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