Full Name:
 

Date of Birth (mm/dd/yy):
 

Driver’s License Number OR Social Security Number:
 

Phone Number (555/555-5555):
 

Your Email (johndoe@hotmail.com):
 

Have you ever worked at a college bookstore?
 Yes No

Have you ever been fired from a job?
 Yes No

1) Most recent job to date. Please list the name of the business, your immediate supervisor, the phone number, and reason for leaving.

2) Second most recent job to date. Please list the name of the business, your immediate supervisor, the phone number, and reason for leaving.

Are there any special activities or circumstances that can or will affect the amount of hours you are able to work?

Please provide a (1) paragraph minimum explanation of the skills, talents, and abilities that you have to offer to your potential employer:

Please explain why you want to work for us & why we should hire you?

I attest that all of the above statements are true and that I have not misrepresented any information on this document. Any misrepresentations are cause for immediate dismissal from employment.