Mickey Mart Employment Application Name*LastFirstM.I. Address* Street Address City State Postal / Zip Code Email* Position applied for: Are you a U.S. citizen?*YesNo If no, are you authorized to work in the U.S.?YesNo Have you ever worked for this company?*NoYes If so, when? Have you ever been convicted of a felony?*NoYes If yes, please explainEducation High School* * Street Address City State Zip Code Dates Attended* Did you graduate?*YesNo College Street Address City State Zip Code Dates Attended Did you graduate? YesNo Other Street Address City State Zip Code Dates Attended Did you graduate? YesNoReferencesPlease list three professional references (not related to you). Full Name* Company* Relationship* Phone* - Full Name * Company * Relationship * Phone * - Full Name * Company * Relationship * Phone * - Previous EmploymentEnter up to three (3) previous employers. Company * Address * Job Title* Responsibilities:* Phone * - Supervisor* Salary (in $)* Dates worked* Reason for leaving* May we contact them for a reference?*YesNo Company Address Job Title Responsibilities: Phone - Supervisor Salary (in $) Dates worked Reason for leaving May we contact them for a reference? YesNo Company Address Job Title Responsibilities: Phone - Supervisor Salary (in $) Dates worked Reason for leaving May we contact them for a reference? YesNoMilitary Service Branch Rank at Discharge Dates Served Type of Discharge If other than honorable, explain:Disclaimer and SignatureMy signature below certifies that my answers are true and complete to the best of my knowledge.If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signature* Date * Phone Number*SubmitReset