Sumner Skate Zone Application

Date: ____/____/____
Name:________________________________________________________  Male/Female
Address:________________________________________________________________
Phone Number:______________________        Other Phone:_______________________
Date of Birth:______/_____/________  Age:_ _____ SS #________-______-__________
Name of School:___________________________________ Grade:_______ GPA:_______
Extra Curricular Activities:____________________________________________________

WORK EXPERIENCE:

Employer:__________________________________ Phone Number:_________________
Job Title:_________________________________  Supervisor:_____________________
Duties:___________________________________________________________________
Start Date/Pay:______________/__________   End Date/Pay:_____________/__________
Reason for Leaving:_________________________________________________________

Personal References:

Name:_______________________________        Name:____________________________
Phone Number:_______________________         Phone Number:_____________________
Relationship:_________________________         Relationship:_______________________

Pre-Interview Questions
Do you have provided transportation?  Yes/No
Are your parents aware of this application?    Yes/No
Would there be an issue with working late hours?    Yes/No
Are there any restrictions on working?    Yes/No
             If yes, please explain:_______________________________________________
Are you seeking part-time or full-time work?______________
What rate of pay are you seeking? ____________/hour            Flexible?  Yes/No

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