Hiway Burger

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Name *
Address *
City *
Zip Code *
County *
Phone *
Day Phone (If Different) *
Social Security Number
Date of Birth *
Email Address *
Part Time or Full Time *	Part Time Full Time
Are you seeking a management position? *	Yes No
Are you 18 years or older? *	Yes No
Availability (Please list days and times) *
If hired can you show proof of your legal right to work in the U.S. ? *	Yes No
Have you ever been dismissed, or asked to resign from any position? *	Yes No
Have you been convicted of a felony which resulted in imprisonment? *	Yes No
If yes to either of the above questions, please explain:
Qualifications *
Education *
Employment Experience (List past 3 jobs, name & address, position held & date at job) *
References (List at least three) *
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	* I certify that all statements made herein and on the enclosed resume are true and correct to the best of my knowledge. I authorize investigation of all statements herein recorded. I release from liability all persons and organizations reporting information required by this application.
Digital Signature *