subject_line
Summerhays Employment Application
Full Name
*
Email Address
*
Phone Number
*
Social Security Number (Last four numbers only)
*
Present Address
*
Permanent Address
*
Type of employment desired?
*
Full-Time
Part-Time
Temporary
Seasonal
Position Desired
*
Date you can start
*
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Schedule Available Days & Hours
*
Mon
Tue
Wed
Thur
Fri
Sat
8am
Mon
Tue
Wed
Thur
Fri
Sat
9am
Mon
Tue
Wed
Thur
Fri
Sat
10am
Mon
Tue
Wed
Thur
Fri
Sat
11am
Mon
Tue
Wed
Thur
Fri
Sat
12pm
Mon
Tue
Wed
Thur
Fri
Sat
1pm
Mon
Tue
Wed
Thur
Fri
Sat
2pm
Mon
Tue
Wed
Thur
Fri
Sat
3pm
Mon
Tue
Wed
Thur
Fri
Sat
4pm
Mon
Tue
Wed
Thur
Fri
Sat
5pm
Mon
Tue
Wed
Thur
Fri
Sat
6pm
Mon
Tue
Wed
Thur
Fri
Sat
7pm
Mon
Tue
Wed
Thur
Fri
Sat
Salary Requirements
*
Are you legally allowed to work in the United States?
*
Yes
No
Ever applied to this company before?
*
Yes
No
*
Where
When
Previous Application
Where
When
Upload your resume
*
Education History
Name & Location of High School
Name
Location
High School
Name
Location
Name & Location of College
Name
Location
College
Name
Location
Trade, Business, or Correspondence School
Degrees completed
Subjects Studied
Did you Graduate?
Yes
No
Years attended
Would you like to include additional education history?
*
Yes
No
Additional Education History
Other Subjects Studied
Years attended
Did you Graduate?
Yes
No
Summarize Your Special Skills or Qualifications
Summary Comments
*
Previous Employment (begin with most recent position)
Company Name
Position(s) Held
Dates of Employment:
From
+
To
+
Company Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Phone Number
Supervisor Name & Title
Name
Title
Supervisor
Name
Title
Responsibilities
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Would you like to include additional employment history?
*
Yes
No
Additional Employment History
Company Name
Position(s) Held
Dates of Employment:
From
+
To
+
Company Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Phone Number
Supervisor Name & Title
Name
Title
Supervisor
Name
Title
Responsibilities
Reason for Leaving
May we contact this employer for a reference?
Yes
No
Would you like to include additional employment history?
*
Yes
No
Additional Employment History
Company Name
Position(s) Held
Dates of Employment:
From
+
To
+
Company Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
Phone Number
Supervisor Name & Title
Name
Title
Supervisor
Name
Title
Responsibilities
Reason for Leaving
May we contact this employer for a reference?
Yes
No
References
Give below the names of three persons not related to you, whom, you have known at least one year
*
Name
Phone Number
Address
Business
Years Known
1
Name
Phone Number
Address
Business
Years Known
2
Name
Phone Number
Address
Business
Years Known
3
Name
Phone Number
Address
Business
Years Known
*
""I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americas with Disabilities Act (ADA) and other relevant federal and state laws.”
Signature of Applicant
Type full name here as your official digital signature:
*
Date
*
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