For Which Location are you applying?: Mosby North Kansas City South Liberty Excelsior Springs Kearney North Liberty Claycomo North Oak

For Which Position are you applying?: Sales Clerk Assistant Manager Manager Maintenance

Are you at least 21 years old?: Yes No

Email:

Name:

Address:

City:  State:   Zip: 

Phone:

Date you can start:

Desired starting pay:

Days available to work:

How many hours/week do you want:

What hours/shifts are you available:

Willing to work nights: Yes No

Willing to work weekends: Yes No

Willing to work overtime: Yes No

Willing to work holidays: Yes No

Did you complete High School/GED: Yes No

If not, highest grade completed:

Name of other schools completed:

Degrees obtained:

Present or last employer:

Address:

City, State, Zip:

Start Date - End Date:

Starting and Ending Salaries:

Supervisors Name:

Position and Description of Work:

Reasons for Leaving:

Previous employer before the above:

Address:

City, State, Zip:

Start Date - End Date:

Starting and Ending Salaries:

Supervisors Name:

Position and Description of Work:

Reasons for Leaving:

Have you ever been convicted of a crime besides a minor traffic violation: No Yes (a Yes answer will not necessarily disqualify you)

If so, when:

If so, please list details: