Employment Opportunities

Date of Application

Personal Information

Your Name (First, Middle, Last)

Your Phone

Your Email

Are You 18 or Older?
 Yes No

Your Address

How long have you lived at this address?

Have you ever been previously employed at Jack Brown Cleaners?
 Yes No

If so, explain when and reason for leaving

How were you referred to Jack Brown Cleaners?

Type of Employment Applying
 Part Time Full Time

Job Position Desired

Area of Town Prefer to Work

Days & Hours Available to Work

If hired, on what day can you begin work?

If hired, do you have reliable transportation to get to work?

Legal Information

Have you ever been discharged from a job?
 Yes No
If yes, please explain

Have you ever been convicted of a crime other than a minor traffic violation?
 Yes No
If yes, please explain

Employment Information

Last Employer

Position held

Rate of pay

Employment Date
From To

Reason for leaving

Education Information

High School

 Yes No

College/Technical School

 Yes No

If a job is offered, will you be able to provide legal verification of your eligibility to work in the U.S.?
 Yes No

Your Message


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