Step 1 of 6: Cashier Employment Application

Please fill out this form in its entirety.

* First Name
 * Last Name
 Middle
 Date
Select Date

Present Address
* Street Address
 * City
 * State/Province
 * Postal Code
* Phone
 Email

Permanent Address
Street Address
 City
 State/Province
 Postal Code
* Are you 19 years or older?
Yes No 		* Are you 16 years or older?
Yes No

Education
* Are you still a student?
 Where
 Major/Area of Study
 Expected Graduation Date
Select Date
* Are you a college graduate?
 Where
* High school graduate?
 Where

Driving Information
Driver's License #
 License State
Driver's Expiration
Select Date		 Have you been convicted of a DUI within the last five years?
Yes No

Background Information
* Have you been convicted of a felony within the last 7 years?
Yes No
If yes, explain below (conviction will not necessarily disqualify applicant from employment).

Physical Limitations
* Are you able to lift 20 lbs. numerous times throughout the day?
Yes No 		* Are you able to lift up to 50 lbs?
Yes No
* Are you able to remain standing on concrete for up to 5 hours?
Yes No 		* Are you able to remain standing on concrete for up to 8 hours?
Yes No
* Are you able to bend or squat repeatedly over an extended period of time?
Yes No 		* Are you able to perform tasks with your hands/fingers throughout the day(hold, grasp, pick, pinch)?
Yes No
* Are you able to work outdoors (including extreme heat, sun and cold) for 5 to 8 hours?
Yes No
If no to any question, what can be done to accommodate your limitation?

Special Skills
Do you have any special skills which you would like to tell us about?
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