EmailMe Form - Lees Market Job Application

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email

Position Being Applied For

Available Start Date

MM / DD / YYYY

Weekly Availability

Days, Nights, Weekends, Etc.

Are You Legally Eligible For Employment In This County?

Yes

No

Are You Over 18 Years Of Age?

Yes

No

If You Are Under 18 Years of Age, Can You Furnish a Work Permit?

Yes

No

Not Applicable (Over 18)

Have You Ever Worked For This Company Before?

Yes

No

If You Have Worked For This Company, Please List Approximate Dates of Employment and Job Title.

Leave blank if you have never worked here in the past.

If Applicable, List Your Last Three Jobs, Beginning with Current Employer, Dates of Employment, and Job Responsibilities.

May We Contact Your Current Employer?

Yes

No

Please Provide Two References, Relationship, and Contact Information For Each.

Any Additional Information You Would Like To Include?