(229) 245-8267 - Baytree 1337 Baytree Rd. Suite G. Valdosta, GA 31602
(229) 469-4276 - N. Oak St Ext 3215 N. Oak St. Ext Suite C. Valdosta, GA 31602

Employment

Employment Application

Name:*
Address:*
Phone:*
Email:*

What Days are you able to work?
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

What shifts are you able to work?
MorningNoonEvening

Are you 18 years old or older?
YesNo

Are you a U.S. citizen or approved to work in the United States?
YesNo

Have you ever plead guilty to or no contest to a felony charge?
YesNo

If you answered yes to the previous question please explain the charge, charge date, and disposition.

Current Employment Information
Name of Business:
Current Supervisor:
Current Supervisor Phone #:
Date Hired:
May we contact this employer?
YesNo

Previous Employer
Name of Business:
Previous Supervisor:
Previous Supervisor Phone #:
Start Date:
End Date:
Reason for Leaving:

References
Reference #1:
Reference #2:

Attachments
Resume:
(Acceptable File Types: .txt, .pdf, .doc, .docx)

Current Photo:
(Acceptable File Types: .jpg, .jpeg, .gif, .png, .pdf)

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.