Job Application: Staff

Title: Staff

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Details

Name *
Last Name *

Contact Details

Address *
City *
State *
Zip Code *
Cell phone *
E-Mail Address *


Did you graduate? Yes
Not Yet
High School *
Did you Graduate * Yes
Not Yet
Please List Your Weekly Availability *
If under 18 years of age, Please give DOB:
Have you ever been convicted of any offences other than a minor traffic violation: * Yes
Do you smoke tobacco products or are addicted to any illegal drugs?: * Yes
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the employers and references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal, or otherwise, and release from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any employment agreement and any such employment shall be ‘at will’ This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans With Disabilities Act and other relevant Federal and State laws: * Accept
Do Not Accept