Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Phone *

Location Applying For *Enid, OKEdmond, OKJunction City, KSManhattan, KSPonca City, OKSalina, KSStillwater, OKTopeka, KS

Position Applied For *

Date Available *

Availability

• Sunday

To:

From:

• Monday

To:

From:

• Tuesday

To:

From:

• Wednesday

To:

From:

• Thursday

To:

From:

• Friday

To:

From:

• Saturday

To:

From:

Are there certain times you are unavailable? If so, please list here.

Are you 21+ years of age? *

• Yes
• No

Are you a citizen of the United States? *

• Yes
• No

If no, are you authorized to work in the U.S? *

• Yes
• No

Have you been employed with us previously? *

• Yes
• No

If yes, When?

Have you ever been convicted of a Felony? *

• Yes
• No

If yes, explain

Education

Highschool *

Degree *

College

Degree

Other

Degree

References

Name

First

Last

Relationship

Address

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Phone

Name

First

Last

Relationship

Address

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Phone

Name

First

Last

Relationship

Address

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Phone

Previous Employment

Company *

Phone *

Starting Hourly Wage

Ending Hourly Wage

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

From

To

May we contact your previous supervisor? *

• Yes
• No

Company

Phone

Starting Hourly Wage

Ending Hourly Wage

Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

From

To

May we contact your previous supervisor?

• Yes
• No

Company

Phone

Starting Hourly Wage

Ending Hourly Wage

Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

From

To

May we contact your previous supervisor?

• Yes
• No

Military Service

Have you served in the military? *

• Yes
• No

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

Employment Test

Which of your qualities would you say would contribute the most to the Juicy's Team? *

A customer states that he was short 9 cents in change after receiving 45 cents instead of 54, how would you handle this situation? *

As far as Juicy's is concerned please rank the following in order of importance from most important to least: Great Product, Quick and Friendly Service, Comfortable Environment (Explain) *

You are asked to extend your shift for two more hours, you already have plans to view a movie with your friends during that time, how would you handle this situation? *

Attach Resume here if available.

Click or drag files to this area to upload. You can upload up to 3 files.

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