Splash Amarillo Application for Employment Personal Data First Name: Middle Name: Last Name: Social Security Number: Address: City: State: Zip: Phone Number: Email Address: Are you 18 years of age or older? yes   no Date of Birth: Are you prevented from lawfully becoming employed in this country because of visa or Immigration status? yes   no Employment Desired Position Desired: Date you can start: Salary Desired: Are you employed now? yes   no If so, may we inquire of your current employer? yes   no Ever applied to this company before?  yes   no Where? When?  Referred by? Days Available to Work? Any days you will need off during the season? If needing to leave for school before we close, when will be your last day? Education Name, Location, Years, Subject Studied Grammar School High School College Trade, Business or Correspondence School General   Special Skills: Activities: (Civil, Athletic, etc) U.S. Military Service: (list rank) Present Membership of the National Guard or Reserves: Former Employers   Date Month and Year: Name and Address: Salary: Position: Reason for Leaving:     Date Month and Year: Name and Address: Salary: Position: Reason for Leaving:     Date Month and Year: Name and Address: Salary: Position: Reason for Leaving:     Date Month and Year: Name and Address: Salary: Position: Reason for Leaving:     References   Name: Address: Business: Years Acquainted:     Name: Address: Business: Years Acquainted:     Name: Address: Business: Years Acquainted:     Any back problems? yes   no Able to life 100 lbs? yes   no