Position(s) Applied For: (Required)

First Name: (Required)

Last Name: (Required)

Address: (Required)

City: (Required)

State: (Required)

Zip Code: (Required)

Home Number: (Required)

Cell Number: (Required)

Social Security No. (Voluntary):

If you are under 18 years of age, can you provide required proof of your eligibility to work: (Required)

Yes

No

Have you ever filed an application with Lefty's before? (Required)

Yes

No

If yes, give date:

Have you ever been employed with Lefty's before? (Required)

Yes

No

If yes, give date:

Do any of your friends or relatives, other than spouse, work here? (Required)

Yes

No

Are you currently employed? (Required)

Yes

No

May we contact your employer?

Yes

No

Are you legally eligible for employment in the U.S.? Proof of citizenship or immigration status will be required upon employment. (Required)

Yes

No

Have you been convicted of a crime?Admission of crime may not constitute denial of employment. (Required)

Yes

No

Date you are available to work: (Required)

What is your desired salary? (Required)

Are you available to work: (Required)

Full-Time

Part-Time

Temporary

Would you be interested in catering? (Required)

Yes

No

Do you have transportation? (Required)

Yes

No

List the days/times you are not available to work? (Required)

Elementary School Name and Address: (Required)

Elementary School Course of Study: (Required)

Elementary School - Number of Years Completed: (Required)

Elementary School Diploma or Degree: (Required)

Middle School Name and Address: (Required)

Middle School Course of Study: (Required)

Middle School - Number of Years Completed: (Required)

Middle School Diploma or Degree: (Required)

High School Name and Address: (Required)

High School Course of Study: (Required)

High School - Number of Years Completed: (Required)

High School Diploma or Degree: (Required)

College/University Name and Address: (Required)

College/University Course of Study: (Required)

College/University - Number of Years Completed: (Required)

College/University Diploma or Degree: (Required)

Other (specify) Name and Address:

Other (specify) Course of Study:

Other (specify) - Number of Years Completed:

Other (specify) Diploma or Degree

Company: (Required)

Phone Number: (Required)

Address: (Required)

City/State/Zip: (Required)

Date of Employment (From): (Required)

Date of Employment (To): (Required)

Beginning Salary: (Required)

Ending Salary: (Required)

Job Title: (Required)

Supervisor's Name and Title: (Required)

Describe Duties: (Required)

Reason for Leaving: (Required)

Company:

Phone Number: (Required)

Address:

City/State/Zip: (Required)

Date of Employment (From):

Date of Employment (To):

Beginning Salary:

Ending Salary:

Job Title:

Supervisor's Name and Title:

Describe Duties:

Reason for Leaving:

Company:

Phone Number:

Address:

City/State/Zip:

Date of Employment (From):

Date of Employment (To):

Beginning Salary:

Ending Salary:

Job Title:

Supervisor's Name and Title:

Describe Duties:

Reason for Leaving

Company:

Phone Number:

Address:

City/State/Zip:

Date of Employment (From):

Date of Employment (To):

Beginning Salary:

Ending Salary:

Job Title:

Supervisor's Name and Title:

Describe Duties:

Reason for Leaving:

Summarize special job-related skills and qualifications acquired from employment or other experience:

Name: (Required)

Phone Number: (Required)

Address: (Required)

City: (Required)

State: (Required)

Zip: (Required)

Name: (Required)

Phone Number: (Required)

Address: (Required)

City: (Required)

State: (Required)

Zip: (Required)

Name: (Required)

Phone Number: (Required)

Address: (Required)

City: (Required)

State: (Required)

Zip: (Required)

Signature of Applicant: (Required)

Date: (Required)