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N8770 Fire Lane # 1
Menasha, WI 54952
Phone 920-733-9721
Fax 920-733-3357

Applications are considered for all positions without regard to race, color, religion, sex, national origin, age, sexual orientation, marital or veteran status, disability or any other basis prohibited by federal or state law.

Date of Application

Position(s) Applied For

Wage or Salary Expected $ per

Referal Source:(Please write specific source)

Advertisement:		Employment Agency:
Walk-In:		Other:

Wavelry Beach Associate:

Name
	LAST	FIRST	MIDDLE

Address
	ADDRESS	CITY	STATE	ZIP CODE +4

Telephone	()		()
		Home		Work(If able to contact you)

E-Mail Address

Drivers License Number

State

Expiration Date

Are you 18 years of age or older?

Yes

Have you filed a Waverly application before?

Yes If yes give date

Have you ever been employer here before?

Yes If yes give date

Are you employed now?

Yes

May we contact your present employer?

Yes

Are you a US citizen or do you have
any entry permit which allows you to work?

Yes

On what date would you be available for work?

Are you available to work?

(Check all that apply)

Full Time Part Time Shift Work
Temporary Weekends (Reasonable effort will be made to accomodate religious needs)

Number of hours per week desired

Hours available

Are you on a lay off and subject to recall?

Yes

Have you ever been convicted of a crime (misdemeanor or telony) or current charges pending?	No Yes
	(Does not necessarily bar you from employment)

Please Explain

Employment Experience

Please list all positions held. Start with you present or last job. Include military service assignments. Explain any gaps in employment in comment section below.

Employer

Street

City, State

Telephone No.

()

Job Title

Supervisor

Reason for Leaving

Dates Employed

From	To

Hourly Rate/Salary

Starting	Final

Describe in detail the work you performed

Employer

Street

City, State

Telephone No.

()

Job Title

Supervisor

Reason for Leaving

Dates Employed

From	To

Hourly Rate/Salary

Starting	Final

Describe in detail the work you performed

Employer

Street

City, State

Telephone No.

()

Job Title

Supervisor

Reason for Leaving

Dates Employed

From	To

Hourly Rate/Salary

Starting	Final

Describe in detail the work you performed

Employer

Street

City, State

Telephone No.

()

Job Title

Supervisor

Reason for Leaving

Dates Employed

From	To

Hourly Rate/Salary

Starting	Final

Describe in detail the work you performed

I am the person applying for this positions and all of the above information is true to my knowledge.