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1. Date (Required.)

Date

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2. Full Name (Required.)

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3. Street Address (include City, State, Zip) (Required.)

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4. Phone Number (Required.)

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5. Email Address (Required.)

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6. Do you have a high school diploma or GED? (Required.)

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7. Are you 18 years of age or older? (Required.)

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8. Position Desired (Required.)

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9. What are your salary requirements? (Required.)

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10. What is your desired schedule (Required.)

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11. There are opportunities for overtime and required Saturdays occasionally. Are you willing to work those days? (Required.)

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12. If the position you are applying for requires the operation of a motor vehicle, do you have a valid license? (Required.)

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13. Are you a US citizen, or do you have the legal right to employment? (Required.)

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14. Have you been convicted of a felony in the last 7 years? Please note that "conviction" includes plea, verdict, or finding of guilt, regardless of whether you were sentenced by a court. (Required.)

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15. Have you ever been convicted of a misdemeanor within the last 7 years? Please note that "conviction" includes plea, verdict, or finding of guilt, regardless of whether you were sentenced by a court. (Required.)

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16. Are you currently awaiting trial for a felony? A conviction will not necessarily disqualify you from the position for which you are applying. (Required.)

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 25% of survey complete.

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