Sample Application For Employment



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Day   Mon   Tue   Wed   Thurs   Fri   Sat   Sun   From                 To                 Describe  other  activities  that  may  periodically  affect  your  availability,  such  as  sports,  music,  school,  etc…  (Exclude  activities  that  indicate  race,  creed,  color,   sex,  age,  religion,  handicap  or  national  origin.)       If  you  are  under  18  years  of  age,  please  state  your  date  of  birth    //        If  under  18  years  of  age,  how  old  are  you       Are  you  able  to  perform  the  essential  duties  of  the  job  for  which  you  are  applying      Yes      /      No        If  no,  please  describe:       Do  you  have  reliable  transportation  to  work      Yes      /      No     Are  you  legally  eligible  for  employment  in  the  United  States    Yes      /      No      School  Most  Recently  Attended   Name   Teacher  or  Counselor   City  /  State   Grade   Completed   GPA   Graduated     YES                NO   Now  Enrolled     YES            NO   Extracurricular  Activities  (band,  choir,  student  council,  football,  etc…)     Personal  References   Name       Address       Telephone       Name   Name   Address   Address   Telephone   Telephone   Most  Recent  Job    -­‐    May  We  Contact        YES            NO     Company  Name   Phone     Address                                                                                                                                                                                City                                                          State   Job  Title   Salary   Supervisor   Dates  worked:      From  /  To   Reason  for  leaving     Why  would  you  like  to  work  for  Bruster’s       Have  you  ever  worked  at  a  Bruster’s  store  before    If  so,  why  did  you  leave     What  doe

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