L.A. Rays Application Form

DATE ______________________

Print Name ____________________________________________________Date of Birth___________

Address_________________________________________________________Zip________________

Social Security No. _______ – _____ – _________

Telephone (           )_________________________

Days/hours available to work:

No Pref _______                                                          Thur 9 a.m.-4:pm______4 pm-9:pm_____

Mon 9:a.m.-4:pm_____4:pm-9:pm_____                     Fri   9 a.m.-4:pm ______4 pm-9:pm_____

Tue  9:a.m.-4:pm_____ 4:pm-9:pm_____                    Sat 9 a.m.-5 p.m.______4 pm-9:pm_____

Wed 9:a.m.-4:pm_____4:pm-9:pm_____                     Sun 10 a.m.- 4 p.m. ____4 pm-9:pm_____

How many hours can you work weekly? ________________________

NUMBER OF SCHOOL YEARS  COMPLETED__________________

Previous Employment:

Company _______________________start date_________end date__________

Phone number_____________________

Company _______________________start date_________end date__________

Phone number_____________________

HAVE YOU EVER BEEN CONVICTED OF A CRIME? __ No __ Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Sign______________________________________________________________________