Date *

MM

DD

YYYY

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you 18 years of age or older? *

Yes

No

Are you either a US citizen or an alien authorized to work in the US? *

Yes

No

Have you ever worked or attended school under another name? *

Yes

No

Start Date Available *

MM

DD

YYYY

Hourly

Monthly

Annually

Do you prefer *

Full-Time

Part-Time

Are you able to work (check all that apply) *

Weekends

Holidays

Nights

Overtime

Have you previously worked for DTR? *

Yes

No

Graduated? *

Yes

No

Graduated?

Yes

No

Graduated?

Yes

No

Graduated?

Yes

No

Are you experienced in using a computer? *

Yes

No

PC

Mac

Are you able to use Microsoft Word, Excel, and Outlook? *

Yes

No

May we contact?

Yes

No

May we contact?

Yes

No

May we contact?

Yes

No

Reference Name #1 *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Name #2 *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference Name #3 *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you ever been convicted of a felony or misdemeanor or do you currently have a felony or misdemeanor charge pending? Convictions include a plea of guilty nolo contendere (no contest) and/or a finding of guilty by a judge or a jury or a conviction that has been judicially dismissed or ordered sealed including 'expungement' granted pursuant to Penal Code section 1203.4. *

Yes

No

Have you ever been dismissed or asked to resign from any position?

Yes

No

Date

MM

DD

YYYY