Join us at Dairy Star this summer

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Personal Information

Name*

First Last

Address*

Street Address City State ZIP Code

Email*

Phone*

Are you 18 years or older?*

YES

Date of birth*

Are you a US citizen, or an alien authorized to work in the US?*

YES

In case of emergency, please notify:*

First Last

Emergency Contact Address*

Street Address City State ZIP Code

Emergency Contact Phone*

Availability

Date you can start?*

How many hours per week are you seeking?*

What days and times are you available to work?*

Day

Start

End

Do you have reliable transportation to and from work?*

YES

Any other limitations?

i.e. summer school, religous services, etc

Personal Goals

What accomplishments are you most proud of?*

What are your 5-year goals?*

What is your greatest talent?*

Education

Schools Attended*

School Name

# of years attended

Subjects studied

Graduation Date

Elementary, High School, College

Former Employment

List your last four employers, starting with the most recent*

Date

Name and address

Salary

Position

Reason for Leaving

References

List names of three persons not related to you, whom you have known at least one year.*

Name

Phone

Business

Years Known

Special Skills or Qualifications

Summarize any special skills or qualifications you have:*

I certify that my answers are true and complete to the best of my knowledge. I authorize Dairy Star to make such investigations of my personal, employment, educational, financial and other related matters as may be necessary for an emplyment decision. I hereby release employers, schools or individuals from all liability responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may reult in discharge.

Date

Signature*

Name

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