Please provide the following information:
Name: (Last, First, Middle initial)
Address: (Street, Apt#, City, State, Zip code)
How long have you lived at this address?
less than one year
one to three years
three to five years
more than five years
Are you under the age of 18?
Are you under the age of 16?
Primary phone number:
Secondary phone number:
Please indicate the days you are able and available to work:
Wednesday (9am- 5pm)
This position will require you to work evening hours as late as 7PM and Saturdays. Is this something you are able to accommodate?
If considered for this position, what date would you be available to begin work?
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