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Day Mon Tue Wed Thurs Fri Sat Sun From To Describe other activities that may periodically affect your availability, such as sports, music, school, etc… (Exclude activities that indicate race, creed, color, sex, age, religion, handicap or national origin.) If you are under 18 years of age, please state your date of birth // If under 18 years of age, how old are you Are you able to perform the essential duties of the job for which you are applying Yes / No If no, please describe: Do you have reliable transportation to work Yes / No Are you legally eligible for employment in the United States Yes / No School Most Recently Attended Name Teacher or Counselor City / State Grade Completed GPA Graduated YES NO Now Enrolled YES NO Extracurricular Activities (band, choir, student council, football, etc…) Personal References Name Address Telephone Name Name Address Address Telephone Telephone Most Recent Job -‐ May We Contact YES NO Company Name Phone Address City State Job Title Salary Supervisor Dates worked: From / To Reason for leaving Why would you like to work for Bruster’s Have you ever worked at a Bruster’s store before If so, why did you leave What doe
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