Employment Application

Your First & Last Name:

Your Phone Number (Must be text message compatible):

Your Email:

Address:
City:
State:
Zip:

Date of Birth:

Desired position:---Happy Helper - $12.50/hrWorking Leader - $14.50/hrNight Staff - $12.50+/hr

Please check any dates that you are NOT available:Open Availability5/125/135/195/205/265/276/26/36/96/106/166/176/236/246/307/17/77/87/137/147/157/217/227/287/298/48/58/118/128/188/198/258/269/19/29/89/99/15

Are there any times of the day than you can not work? Please Explain:

Have you at anytime worked for Webb's Consulting & Management Services, Inc? ---NoYes

Do you have any relatives or friends working for Webb's Consulting & Management Services, Inc.? ---NoYes

Have you had First Aid Training in past 12 months? ---NoYes

Have you ever been convicted of a felony? ---NoYes
(Convictions will not necessarily disqualify an applicant for employment) If yes, describe conditions.

Highest level of education completed: ---High School - Grade 9High School - Grade 10High School - Grade 11High School - Grade 12High School - GEDTrade/College/University - 13Trade/College/University - 14Trade/College/University - 15Trade/College/University - 16Other
School:
Major:
Graduated?

EMPLOYMENT HISTORY -- List your last 3 jobs, starting with your current or most recent employer.

Employer #1
Company:
Phone:
Address:
Date Started:
Stating Position:
Starting Wage:
Date Left:
Ending Position:
Ending Wage:
Supervisor:
Reason for leaving:
May we contact this employer? ---YesNo

Employer #2
Company:
Phone:
Address:
Date Started:
Stating Position:
Starting Wage:
Date Left:
Ending Position:
Ending Wage:
Supervisor:
Reason for leaving:
May we contact this employer? ---YesNo

Employer #3
Company:
Phone:
Address:
Date Started:
Stating Position:
Starting Wage:
Date Left:
Ending Position:
Ending Wage:
Supervisor:
Reason for leaving:
May we contact this employer? ---YesNo

In case of emergency, contact:
Relationship:
Phone Number:

Shirt Size (Men's Sizes): ---SmallMediumLargeX-LargeXX-LargeXXX-Large

Have a Resume? Upload it here:

I do attest to the truth and accuracy of all information listed in this application. Electronic Signature.
Name & Last Name AND Birth Year: