Management Office

Office Number

Availability Survey ****

F O R E M P L O Y M E N T W I T H S T A F F M A N A G E M E N T S M X AT B W A Y

Name (First & Last Name) Employee #

Lemmie Fletcher 1204905

Primary Phone Today’s Date

773-***-**** 06-18-2013

The following are the available shifts. Please keep in mind that you must be available to work weekends.

Please choose the shift that you may be interested in and is of preference working.

Label them “1” for 1st choice and “2” for 2nd choice.

I N D I C AT E Y O U R P R E F E R R E D S H I F T

FULL-TIME SHIFTS (Times/Days are Approximate)

Option 1 1st Shift Monday – Friday 4:30 am – 3:00 pm (10 hrs)

Option 2 1st Shift Monday – Friday 6:00 am – 2:30 pm (8hrs) *

Option 3 1st Shift Monday - Friday 6:00 am – 6:00 pm (12 hrs)

Option 4 2st Shift Monday - Friday 3:00 pm – 1:30 am (10hrs)

Option 5 2nd Shift Monday - Friday 6:00 pm – 6:00 am (12 hrs)

Option 6 3rd Shift Monday - Friday 10:00 pm – 6:30 am (8hrs)

Option 7 3rd Shift Monday - Friday 11:00 pm – 6:00 am (8 hrs)

Option 8 ANY Any Shift Open Availability

*This schedule is limited and not typically used for FT positions.

The options bolded are shifts we have availability at this present time. Further information will

be clarified during the recruiting process.

AGREEMENT AND SIGNATURE

I agree and attest under penalty of perjury that I am the person identified in this document and that all the information included herein is true

and accurate. I am at least 18 years old and able to produce legal proof of identification matching my identity in this document. I certify that

the facts in this employment application are true and complete. I understand that falsified statements are grounds for dismissal.

Today’s Date

Legal First & Last Name

Signature

06-18-2013

Submittal

Once you have checked/clicked on either “Signature Submittal” OR “I agree and attest..” checkboxes, you may not edit any other field in this form. If

you find that you need to edit a field, un-check BOTH “Signature Submittal” and “I agree and attest..” and this will allow you to edit. Please also note

that once you click to “Submit” this document, it may be edited by contacting someone on the Staff Management/SMX Recruiting Team.

Lemmie

Lemmie Fletcher Lemmie Fletcher

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