PLEASE COMPLETE IN FULL.PRINT,

USING INK – DO NOT USE PENCIL

Personal Information

First Name Middle Last

Street Address

City State

Home Phone Number Cell Phone Number Best Time to Call Are you under the age of 18? Yes No If yes, date of birth Have you ever been convicted of a crime? Yes No Do you have a legal right to work in the United States? Yes No Position Information

Number of hours per week desired? What is your wage expectation? Do you object to weekend work? Yes No

Do you object to work 7p.m. to 11p.m.? Yes No Do you have transportation to and from work? Yes No If hired, when could you begin work? Will you be taking a vacation, attending summer camp, or going on spring break Yes No

If yes, when?

Education

High School Information

School Name Last Grade Completed GPA Sports or Activities involved in: College Information

School Name Years Completed GPA

Major:

Graduation Date

Previous Employment

Indicate all positions held. Begin with your most recent employer Company Name Phone Number Supervisor Wage Your position Reason for Leaving Dates of employment: From To Company Name Phone Number Supervisor Wage Your position Reason for Leaving Dates of employment: From To Company Name Phone Number Supervisor Wage Your position Reason for leaving Dates of employment: From To May we contact your current and/or previous employers? Yes No Personal and/or Professional References

Please list at least two references (other than immediate family/household members). Name Company Phone Number Relationship Name Company Phone Number Relationship Name Company Phone Number Relationship Why do you want to become a Dairy Del employee? Applicants Signature

By signing I declare that the above is true and has been completed to the best of your knowledge. I understand that if employed, any falsification, misstatement, or omission of fact in connection with my application, may result in immediate termination of my employment. I authorize to verify any and all information listed above. I understand that, if hired, my employment will be on an at-will bias, meaning that either my employer or I have the right to terminate the employment relationship at any time and/or for any reason.

Dairy Del sets high standards for its employees, and compliance with these standards is a condition of employment. You should carefully consider what we require of our employees before you apply for a position with us.

Applicants Signature

Today’s Date

Thank you for applying