Employment Application

9 White Deer Plaza

Sparta, NJ 07871

Name

First NameLast Name

Middle

Birth Date

Date

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Format: (000) 000-0000.

Do you have reliable transportation to meet any scheduled shifts?

How

Can you read at a 6th grade level?

Have you been convicted of a crime?

Have you been convicted of a felony?

Have you ever worked for us before?

If so under what name/when

Can you provide proof that you are over 16 years of age

18 years of age

21 years of age

Do you have a valid drivers license?

Do you have a legal right to work in the United States?

Can you provide documentation?

Is there any reason you could not perform all physical aspects of this job (including being able to lift up to 50 pounds?)

If yes, please provide details

Is additional information concerning change of name necessary to check work or education?

If yes please explain

Describe your use of drugs and alcohol

Do you smoke/vape?

If yes, can you work 6 hours straight without a smoking break?

What position are you applying for?

Who should we thank for referring you to us?

When are you available to start?

What shifts/times are you available to work? (Employees must be able to work a minimum of two days per week)(Sundays will not be given off but will be rotated fairly between team members)

Please explain the reason for shifts periods that you will NOT be available for

HIGH SCHOOL

City/State

Year Graduated or Years Completed

Extracurricular Activities

COLLEGE

City/State

Year Graduated or Years Completed

Major

Extracurricular Activities

Please start with your most recent position

Employer

Month/Year Hired

Month/Year Left

Job Title

Reason for Leaving

Leaders Name

Position

Phone

Format: (000) 000-0000.

Employer

Month/Year Hired

Month/Year Left

Job Title

Reason for Leaving

Leaders Name

Position

Phone

Format: (000) 000-0000.

Anything else you would like us to know?

OFFICE USE ONLY:

Position
Hire Date
R.O.P.
Emergency Contact Name
Relationship to Contact
Contact Number:

EMPLOYMENT APPLICATION

EDUCATION:

WORK EXPERIENCE