We consider applicants for all positions without regard to race,
 color, religion, sex, national origin, age, marital or veteran
 status, the presence of a non job related medical condition or 
 handicap, or any other legally protected status.
 
 Positon Applied For_____________________  Date_________________
 Name    _______________________________________________________
 Address _______________________________________________________
         _______________________________________________________
 Day Time Phone ________________________________________________
 Other Phone ___________________________________________________
 
 If you are under 18 years of age, can you provide required proof
 of your eligibility to work?                     Yes____ No____
 
 Are you currently employed?                      Yes____ No____
 
 Are you prevented fro lawfully becoming employed in this country 
 because of Visa or Immigration Status?           Yes____ No____

 On what dates would you be available to work? _________________

 Please give 3 references other than family members...
 (please include name,address, and phone numbers)
 
 1.


 2.

 
 3.