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About the Job:

How did you hear about this job?

Which do you prefer?Full Time Part Time

Please fill in the following 3 lines after printing page.

How many hours per week ____  Desired wage: $________ per hour

Circle Days available:    MON    TUES   WED    THUR    FRI     SAT    SUN

Hours available:  ____     ____    ____   ____   ____   ____   ____      

About Your Education:

Did you graduate from High School?Yes No  

Do you have a GED?YesNo  Any schooling beyond H.S.Yes No

Former Employers: List last three employers, starting with last one first.

       From:   To:
 Company:

Phone#:Supervisor:
 Wages:  Position:
 Duties:
Reason for Leaving:

       From:   To:
 Company:

Phone#:Supervisor:
 Wages:  Position:
 Duties:
Reason for Leaving:

       From:   To:
 Company:

Phone#:Supervisor:
 Wages:  Position:
 Duties:
Reason for Leaving:

Please print before exiting page.

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