General Information

Have you ever used another name for work or school? *
YesNo

If yes, please state name(s), time period used and schools/employers

Have you been employed by Luckys before? *
YesNo

If yes, Dates, Location(s), Position(s)

Are you 18 or older? *
YesNo

Are there any days or time periods you are unavailable for work? *
YesNo

If yes, please indicate the days/times


How many hours are you regularly available for work each week? *

Date you are available to begin work? *


Position(s) you are applying for? *

Do you plan to engage in other work while in our employ? *
YesNo

If yes, please list place of employment and describe the work as well as the hours



Are you willing and available to work flexible hours, which could include nights, weekends, holidays, or overtime? *
YesNo

Do you have reliable transportation to work? *
YesNo

How much money do you need to make on a weekly basis? *

Have you ever been fired? *
YesNo

If yes, please explain:

Do you have any relatives and/or roommates that work for Luckys *
YesNo

If yes, please specify:



Are you able to perform the essential job functions of the position for which you are applying, with or without reasonable accommodation? *
YesNo

Education

High School Attended (Name, City, State) *

Did you graduate? *
YesNo

Higher Education attended (Name, City, State) *

Did you graduate? *
YesNo

Employment Information/History

Reason for leaving

Reason for leaving

Reason for leaving