Name *

First Name

Last Name

Work Availability *

Please check all that apply

Opening

Mid-day

Closing

Weekends

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Are you a citizen of the United States? *

I am a citizen of the United States

I am not a citizen of the United States

If no, are you authorized to work in the United States?

Yes, I am authorized to work in the United States.

No, I am not authorized to work in the United States.

Have you ever worked for this company? *

I have previously worked at The Fitness Loft

I have NOT previously worked at The Fitness Loft

Have you ever been convicted of a felony? *

I have never been convicted of a felony

I have been convicted of a felony

Reference 1 Name *

First Name

Last Name

Reference 1 Phone Number *

(###)

###

####

Reference 2 Name

First Name

Last Name

Reference 2 Phone Number

(###)

###

####

Contact Phone Number

(###)

###

####

Contact Phone Number

(###)

###

####