Employment Application - Print, Complete and Bring to Jan's

	Employment Application An Equal Opportunity Employer
Position Applied For: ____________________________			Todays Date: ______________________

Name:		Phone:
Address: (Street, City, State, Zip Code)		Cell:
Date of Birth:	Drivers License Number:	Are You Under 18: YES - NO
Have you ever been convicted of a crime?: YES - NO (If yes, please ezplain on the back side of this application)
Are you legally eligible for employment in the US?: YES - NO		Date Available to Start:

Availability:	(Circle the days & hours you CAN work --- X-out the days & hours you CANNOT work)
Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Lunch	Lunch	Lunch	Lunch	Lunch	Lunch	Lunch
Dinner	Dinner	Dinner	Dinner	Dinner	Dinner	Dinner

Work History:		(Start with your current or most recent employer)
From:	To:	Employer:	Phone:
Job Title:		Duties/Responsibilities:
Supervisor:
Wage:		Reason for Leaving:

From:	To:	Employer:	Phone:
Job Title:		Duties/Responsibilities:
Supervisor:
Wage:		Reason for Leaving:

References:	(Include Name, Address & Phone Number)
1.
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