Date

MM

DD

YYYY

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Are you 18 years or older? *

Yes

No

Have you ever worked for this company before? *

Yes

No

Are you authorized to work in the U.S. on an unrestricted basis?

Yes

No

Do you have a valid Washington State Driver's License? *

Yes

No

Do you have reliable transportation? *

Yes

No

Are you able to lift and carry 75 pounds and walk on a concrete floor 8-10 hours per day? *

Yes

No

Type of employment desired *

Full time

Part time

Available start date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

May we contact this employer? *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

May we contact this employer?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Employment dates *

MM

DD

YYYY

May we contact this employer? *

Yes

No

If current employer is listed, may we contact them after a job offer has been extended and accepted? *

Yes

No

Professional reference #1 *

Please do not list friends or relatives.

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####