Application for Employment: Aplicacion de Trabajo Name Today’s Date: _ ______ ( La Fecha de hoy) Address: County: (Direccion) (Provincia) Phone Number: Email: Zip: ____________ ______ (Telefono) Position Desired: (Posicion) Desired Pay: Cashier□ Cook□ Front□ Other: (Pago deseado) Date You Can Start: Are you at least 18 yrs Old? (Fecha que puede comenzar) ! Yes ! No ¿Tiene por lo menos 18 años de edad? ________________ _______ Days you can work/Shift: ___ Mon ___Tue ___ Wed ___ Thu ___ Fri ___ Sat N/A Sun ___AM or ___PM Días se puede trabajar / Shift: Former Employers: (list the three most current) Date (month & year) Fecha (mes & ano) Name of Business Compania Phone# teléfono Salary Salario Position Posicion Reason for Leaving Razon porque se fue ____ _____ _____ _____ Are you eligible for Re-Hire at your last Job? ! Yes ! No ¿Es usted elegible para reinstale en su último trabajo? Explain: _________________________________________ References: (Referencias) Name Type of Business Phone# Years Acquainted (Nombre) (Compania/Negosio) (teléfono) (Anos con ese Negosio) _____ _____ _____ _____ Education: (Educacion) High school ! Yes ! No Date:_____________ G.E.D. ! Yes ! No Date:______________ _____ _____ Special Training/Skills: (Abiliidades/Especiales) ___________ Why do you want to work at Nancy’s? Porque quiere usted trabajar en Nancy’s? ___________________________________________ _____ Have you been convicted of a crime? ¿Han sido condenados por un delito? ! Yes ! No If yes, state the nature of the offense and disposition of the case. Include dates and places. (NOTE: The existence of a criminal record does not constitute an automatic bar to employment.) ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ MANAGER NOTES (applicant, do not write below) MRG INITS ( ) Availability: Scheduling Conflicts? Overall: FT ! Yes PT WK DYS ! No Notes: WK NTS WK ENDS Second Date: ______________________________________ _________________________ __________________ _________ Rev 07/16 NAME:____________________________________________ POS: Cashier__ Cook ___ Front ____ Other____ (Nombre)