Cragnacker’s Application for Employment

Name____________________________________ Soc. Sec. #_________________________________

Address_______________________________________________________________________________

Phone____________________________________ Position Applying For________________________

Birth date_________________ Dou you have a valid ABC card?_______________________________

Days and Hours available:

Monday________________________________ Tuesday___________________________________

Wednesday_____________________________ Thursday___________________________________

Friday_________________________________ Saturday__________________________________

Sunday________________________________

Work History (5 Years - Start With Most Recent):

1 Employer______________________________ Location___________________________________

Contact_______________________________ Period Of Employment________________________

Phone_________________________________ Reason For Leaving__________________________

2 Employer______________________________ Location___________________________________

Contact_______________________________ Period Of Employment________________________

Phone_________________________________ Reason For Leaving__________________________

3 Employer______________________________ Location___________________________________

Contact_______________________________ Period Of Employment________________________

Phone_________________________________ Reason For Leaving__________________________

4 Employer______________________________ Location___________________________________

Contact_______________________________ Period Of Employment________________________

Phone_________________________________ Reason For Leaving__________________________

5 Employer______________________________ Location___________________________________

Contact_______________________________ Period Of Employment________________________

Phone_________________________________ Reason For Leaving__________________________

Education:

What is the highest level of education you have completed, and where?___________________________

Are you currently a student?____________________________________________________________

Are you a veteran, or currently, a member of the armed forces?_________________________________

If you answered yes to the previous question, what type of training and/or education have you received in

the military?________________________________________________________________________

Have you worked under a nickname, or a different name, that we should know about in order to check a

reference?____ If yes, please list.___________________________________________________________

Are you a citizen of the US?_____ If not, can you be legally employed in the US, and if employed, provide

proof?_____

Have you ever been convicted of a felony?_____

Do you have any physical limitations that would keep you from performing the duties of the job you are

applying for? (i.e. lifting heavy objects, staying on your feet for extended periods):____________________

If yes to the previous question, please list.____________________________________________________

Is there any reason you can’t work Saturdays and/or Sundays?____________________________________

Personal References:

1 Name_________________________________ Address____________________________________

Phone_________________________________ Relation___________________________________

2 Name_________________________________ Address____________________________________

Phone_________________________________ Relation___________________________________

3 Name_________________________________ Address____________________________________

Phone_________________________________ Relation___________________________________