Facility Name:
Last Name:
First Name:
Address:
City:
State:
Zip Code:
Email Address:
Home Phone number:
Cell Phone number:
Do you have any friends or
relatives employed by us?
Yes
No
Are you 16 years of age or
older?
Yes
No
Do you have reliable
transportation?
Yes
No
Date Available to Start?
How many hours a week can
you work?
What shifts do you prefer days or
evenings or either?
Days
Evenings
Either
No
Yes
Can you work Sundays?
No
Yes
Are you currently employed?
Have you been convicted with a
felony within the last 5 Years?
No
Yes
If Yes, please explain:
Please check which apply:
College
High School
Grade-Point Average:
How did you learn about us?
Computer Experience:
List any relevant
experience or training:
Cooperstown Fun Park or Kid's Fun Zone
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