Personal Data
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Position Applied For

Last Name

First Name

Middle Name

Social Security Number

Address Line 1

Address Line 2



Zip Code

Phone Number

If you are under 18 years of age, please specify your age here**

**This information will be used only for child labor law purposes.

Are there any days, shifts, or hours you will not work?

If yes, please explain.

Are you available for out of town work?

Will you work overtime, if required?

When will you be able to start work?

Have you taken any illegal drugs in the last 30 days?

Have you ever been the defendant in a civil action for an intentional tort (intentional commission of wrongful act)?**

**Note: Answering 'Yes' does not automatically exclude you from further consideration for the position.

If yes, include nature of the intentional tort and the disposition of the action.

How did you learn about our company?

If you were referred, who were you referred by?

Have you ever applied or worked at Value Store It before?

If you previously worked for Value Store It, provide employment dates:
Begin Date    End Date

Are you legally authorized to work in the United States?

Will you now or in the future require sponsorship for employment visa status (e.g., H-1B visa status)?

Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.