Application for Weekend Office Assistant


Basic Information


First Name*


Last Name*


Middle Name*


Present Address*








Phone Number*


Permanent Phone Number*


Email Address*


19 years or older?*




Are you currently a student?*




Major/Area of Study?


Expected Graduation Date?


Are you a college graduate?*




Are you a high school graduate?*




Driving Information


Do you have a valid driver's license?*


Driver’s License (State)


License Number


Expiration Date


Have you been convicted of a DUI within the last five years?*


Background Information


Have you been convicted of a felony within the last 7 years?*


If yes, explain below (conviction will not necessarily disqualify applicant from employment)


Special Skills


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


Physical Limitations


Are you able to lift 20lbs numerous time throughout the day?


Are you able to remain standing for extended periods of time?


Are you able to remain sitting for extended periods of time?


Are you able to bend or squat repeatedly over an extended period of time?


Are you able to perform task with your hands/fingers throughout the day (hold, grasp, pick, pinch)?


If no to any question, what can be done to accommodate your limitation?


Employment History


Name & Location of Employer










Your positions / responsibilities


Reason for Leaving

Add another

Personal References






Phone Number

Add another

Other Questions


How did you learn about this opening?


How does a temporary seasonal position fit into your plans?


What about this position appeals to you?


Are you able to work Sat 8am to 4pm and Sun 10am to 6pm?


If no to the above, what change to the schedule would you need?


Release and Confirmation


This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal.

I authorize investigation of all statements contained herein and the referrals listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, any employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.

I understand that entering my full legal name in the box below is the electronic equivalent of a signature.


Enter your full legal name in the box below if you agree to the Release and Confirmation.*


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