First Name:

Last Name:

Prefer to be called by:

Address:

City:

State:

Zip Code:

Email Address:

Phone:

Cellular Phone:

High School

College

College Major

College Year

Interests (clubs, sports, activities, etc.)

Are you currently certified?
Yes No

Are you interested in working at a certain facility?

What major intersection are you close to?

Do you have transportation to work?
Yes No

What date can you start work? (mm/dd/yyyy)

What will be your last day of work? (mm/dd/yyyy)

Company Name

Your Position

Dates Worked

Supervisor's Name

Supervisor's Phone

Job Duties

How did you hear about us?

Emergency Contact Name

Home Phone

Work Phone

Cell Phone

I UNDERSTAND THAT MY EMPLOYMENT WILL BE STRICTLY SUMMER EMPLOYMENT, AND I WILL NOT FILE FOR UNEMPLOYMENT WHEN MY EMPLOYMENT ENDS.

Agree?
Yes No