Employment Application Name (Last, First, Middle) SSN Present Address (Street, City, State, Zip) Day Phone Night Phone Mailing Address (If Different From Above) Years at Present Address Previous Address (Street, City, State, Zip Years at Previous Address Are You 18 Years or Older? Are You 18 Years or Older? Yes No If Hired, Can You Provide Proof of Citizenship or Legal Right to Work in the United States? If Hired, Can You Provide Proof of Citizenship or Legal Right to Work in the United States? Yes No Have You Ever Plead Guilty (Including Deferred Adjudication) or Been Convicted of Any Criminal Offense Other Than Minor Traffic Citations. If Yes, Please Explain Have You Ever Plead Guilty (Including Deferred Adjudication) or Been Convicted of Any Criminal Offense Other Than Minor Traffic Citations. If Yes, Please Explain Yes No Explain (If you Answered "Yes" Above Position Applied For (Clerk, Sales, Success, etc.) Source of Referral (Employee, Website, Social Media, etc.) Date (mm/dd/yyyy) Position Desired Position Desired Full-Time Part-Time 8 + 12 = Submit