Company First Name * Email Address * Today's Date If under 18, please list age. Last Name * Contact Number * Upload Resume Add File Please upload your Resume ADDRESS Street Address Address Line 2 Date you are available to start? Are you a US Citizen Yes No ADDRESS CONT'D City State Zip Code How long have you lived at your current residence? GENERAL What location are you applying for? Bullhead City (1812 Hwy 95, AZ) Kingman (3930 Stockton Hill Rd, AZ) Please select languages you are fluent in. English Spanish French Position Applied For Salary Desired AVAILABILITY How many hours can you work weekly? Can you work nights? yes no Please select work days you are available No Preference Mon Tues Wed Thurs Fri Sat Sun Employment Desired Full-Time Only Part-Time Only Full or Part-Time ADDITIONAL INFORMATION Do you have a driver's license? yes no what is your means of transportation? Have you ever been convicted of a crime? If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation Have you ever been in the armed forces? yes no Are you now a member of the National Guard yes no If Applicable, what was your specialty in the Armed Forces, Date entered, and Discharge date? Did you complete this application by yourself? yes no Use this space to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. EDUCATION School Name Degree/ Date Granted Major Field/ Minor Field EMPLOYMENT EXPERIENCE Employer #1 Dates Worked | From: To: Address / Telephone Number Describe Your Duties Reason for Leaving Employer #2 Dates Worked | From: To: Address / Telephone Number Describe Your Duties Reason for Leaving Employer #3 Dates Worked | From: To: Address / Telephone Number Describe Your Duties Reason for Leaving May we contact your present employer (if applicable) yes no Please list two references other than relatives or previous employers.