First Name Last Name Address City State Zip Code Phone Number E-mail Address Company #1 Phone Number Supervisor Start Date End Date Reason For Leaving Starting Wage Ending Wage Company #2 Phone Number Supervisor Start Date End Date Reason For Leaving Starting Wage Ending Wage Have you ever been convicted of a crime? High College Cashier Kitchen Prep Front Line Prep Supervisor Sunday Day Sunday Night Monday Day Monday Night Tuesday Day Tuesday Night Wednesday Day Wednesday Night Thursday Day Thursday Night Friday Day Friday Night Saturday Day Saturday Night Personal Reference #1 First Name Last Name How long have you known this person? Phone Number Personal Reference #2 First Name Last Name How long have you known this person? Phone Number Business Reference First Name Last Name How long have you known this person? Phone Number Initials Today's Date Please check all shifts you are available to work

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