EMPLOYMENT APPLICATION Employment Application Name * Street Address * Apt, Suite, Bldg. (optional) City * State * Zip * Phone * Email * Are you either a U.S. citizen or an alien authorized to work in the U.S.? * Yes No Are you at least 18 years of age? * Yes No Do you possess a vaild Ohio driver's license? * Yes No Have you ever been convicted of a felony? * Yes No If yes, please provide details. Do you have a reliable form of transportation? * Yes No Would you be willing and able to work on time every day on a regular and consistant basis? Yes No Are you interested in a full or part-time position? Yes No Are there any days or hours you would be unable or unwilling to work? Yes No Previous Employment From-To If yes, please explain. Date you can start: Employer Address Apt, Suite, Bldg. (optional) City State Zip Position Salary Reason for leaving May we contact your most recent employer? Yes No High School Name & Location Number of years attended List any work experience or special skills that you have that may relate to the position for which you are applying: The job you are applying for requires extensive walking, lifting and physical exertion 10-12 hours a day. Can you perform these functions with or without reasonable accomodation? Yes Are you willing to work more than 40 hours per week when necessary? Yes No Are you willing to work Saturday's? Yes No Have you ever had a job that involved customer service where you had to deal with the public face to face? Yes No Have you ever had a job where you were required to work on your own, unsupervised? Yes No How would you rate your mechanical skills or aptitude? None Minimal Good Excellent If you are human, leave this field blank. Submit