Bucky Express

Store Employment Application

First Name			Last Name

Social Security Number

Street	City	State	Zip	Apt #


Telephone	- -		Cell	- -

Have you worked at Bucky's previously?			Yes	No

If so, When?		From		To

Have you ever applied at Bucky's before?			Yes	No

If so, When?

Can your present employer be contacted?			Yes	No

Do you have reliable transportation?			Yes	No

What position are you applying for?

Desired Starting Pay			How many hours per week do you want to work

What times are you available to work?
Are you willing to work: Evenings?			Yes	No
Overnights?			Yes	No
Weekends?			Yes	No
Holidays?			Yes	No

When can you begin work?

Are your at least 19 years old?			Yes	No

Were you referred by a Bucky's employee?			Yes	No