Date: 8/27/2008 Job Seeker's Name First Last Contact Information Phone Cell Phone E-mail Address Street Apt # City State Zip General Info Grade Level Date of Birth (mm/dd/yyyy) Gender Male Female Language Do you speak more than one language? Y N If yes, please specify Times Available to Work Job Type Automotive Babysitting Child Care Computers Food Service Office Work Painting Pet Care Recreational Restaurant Tutoring Household Jobs Yard Work Other Will you consider all job offers? Y N Do You Have Any of the Following? (Please check all that apply) Driver's License Permit to Drive Reliable Transport Working Papers Please list any courses, special skills, training, or experience you possess. Emergency Contact Information Name Street Apt # City State Zip Relationship to You Phone #1 (required) Phone #2 Do you have any allergies, medical conditions, limitations, or restrictions? Y N If yes, please explain Job Assist provides information about TEEN job opportunities and makes no representation about applicants' qualifications and cannot guarantee successful work-applicant matches. I understand and agree
