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Six Beans Job Application Form

Which location(s) are you applying for? *

Apple Valley
Barstow
Hesperia
Victorville

Name *

First

Last

Email *

Phone Number *

Street Adress *

City *

State *

Zip Code *

Are you entitled to work in the USA? *

Yes
No

Are you 18 or older? *

Yes
No

Have you been convicted of a felony or been incarcerated with a felony in the past seven years? *

Yes
No

If yes, please explain:

What position are you applying for? *

How did you hear about the position?

What date would you be availabe to start, if hired?

Monday: what time are you available? *

Tuesday: what time are you available? *

Wednesday: what time are you available? *

Thursday: what time are you available? *

Friday: what time are you available? *

Saturday: what time are you available? *

Sunday: what time are you available? *

How many hours a week would you like to work? *

Do you have reliable transportation? *

Yes
No

List any other applicable special skills, training or proficiencies: *

High School Name and City:

Dates Attended:

month/year - month/year

College or University Name and City:

Dates attended:

month/year - month/year

Prior Work Experience, Employer:

Date of employment:

Position and Pay:

Reason for leaving:

Prior Work Experience, Employer 2:

Date of employment:

Position and Pay:

Reason for leaving:

Phone

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