Job Form We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. Position(s) Applied ForDate of Application MM slash DD slash YYYY First NameLast NameMiddle NameDate of Birth MM slash DD slash YYYY AddressStreetCity:StateZipTelephone NumberEmail If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes NoHave you ever been employed with us before? Yes NoIf YES, provide date: MM slash DD slash YYYY Are you currently employed? Yes NoAre you prevented from lawfully becoming employed in this country because of VISA or immigration status? Yes NoProof of citizenship or immigration status will be required upon employmentOn what date would you be available for work? MM slash DD slash YYYY Are you available to work Full Time Part Time Shift Work TemporaryAre you currently on "lay off" status and subject to recall? Yes NoCan you travel if the job requires it? Yes No