1234 Repair Hwy
Fixit USA 54321
888-555-1212
M-F 8-5 + Sat 8-Noon

Employment

Please carefully complete this entire Pre-application questions below:

First and Last Name *

Your Street Address *

City, State, and Zip *

Area Code and Phone Number *

Your Email Address *

How were you referred to us? *

The position you are seeking *

Pay rate that you desire *

Rate Amount (Indicate dollar amount either hourly or annually) *

Have you ever been employed by us before? *

Yes No

If so when were you PREVIOUSLY EMPLOYED by us (Give dates)

Have you ever APPLIED TO us before? *

Yes No

If so when were you previously employed by us (Give dates)

Are you under the age of 18 *

Yes No

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