NAME:__________________________________________________DATE:____________________

ADDRESS:_____________________________CITY:_________________SATE:______ZIP______

PHONE_________________________CELL:____________________EMAIL__________________

Are you 18 yrs old or older?     YES            NO           Age if under 18__________

If your under 18 years old, do you have or can you secure working papers? YES                 NO

Re you legally able to work in the United States?  YES                NO                (Proof of U.S.                       citizenship or work status will be required upon employment)

Type of employment desired?   Full-Time          Part time             Other

Date you are available to work:________________________

Do you have reliable transportation:____________________

School most recently attended:_________________________

Last grade completed:_________________________________

School sports or activities:_____________________________

Have you applied for work with us before:  YES                 NO

Hours available during school you can work:

Hours available during summer you can work:

The reason I would like to work at the BIG DIPPER ICE CREAM PARLOR:

____________________________________________________________________________________

____________________________________________________________________________________

List two references we may contact (NO RELATIVES)

1-_________________________________________________

2-_________________________________________________

My Last place of employment was:____________________________________

I certify that the information contained in this application is correct to the best of my knowledge

Signature:_____________________________________________DATE:____________________