Name: Last	First	Middle
Street Address	City	State	Zip Code
		Yes No
Email Address	Telephone	Are you over 18?

	School Name / Location	Years Completed	Degree / Diploma
College
High
Middle

Activities / Organizations

Company Name	Location	Supervisor	Employed From/To	Phone #	Salary	Reason for Leaving
Company Name	Location	Supervisor	Employed From/To	Phone #	Salary	Reason for Leaving
Company Name	Location	Supervisor	Employed From/To	Phone #	Salary	Reason for Leaving

	Name	Occupation	Years Known	Telephone #
1.
2.

It is important that we collect information on your availability for the season and we ask that you keep in mind that your responses will play a large factor in the hiring decision.

The first day that I can work is:

The last day that I can work is:

Spring Fall Are you able to work after school during the week? Yes No Yes No If yes, what time can you be here on school days? How many hours a week are you able to work? What is your last/first day of school? Are you able to work Saturdays? Yes No Yes No Are you able to work Sundays? Yes No Yes No

If you have any special scheduling needs during either the Spring or the Fall due to sports, band practice, etc., please indicate it here:

Summer:

How many hours a week are you able to work?

What days/times are you available?

Saturday     Sunday Monday Tuesday Wednesday Thursday Friday

Please indicate any vacations/special occasions that you have planned for the summer:

REASON DATE(S) REASON DATE(S)

Any additional information:

I understand that any desired changes to the above schedule must be approved by my manager and may affect my employment status.

I authorize the above employer to obtain information about me from my previous employer(s), schools, and references. I authorize my previous employers, schools that I have attended, and references to disclose to the above employer such information about me as the employer may request. I attest that the above information is true and complete. I understand that if I am hired, any false or incomplete statements in this application will be grounds for immediate discharge.
Applicant's Signature		Date

We are an equal opportunity employer, we do not discriminate on the basis of age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.