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Personal Information
Name
Address 1
Address 2
City
State
Zip
Telephone No.
E-mail Address
Are you known by another name?	Yes No
If yes, by what name?
Are you a U.S. Citizen?	Yes No
Employment for non-U.S. citizens is dependent on appropriate visa status

Job Interest
Are you willing to work overtime?	Yes No
Are you willing to work weekends?	Yes No
Are you willing to relocate?	Yes No
Kind of work desired or area of interest
	Full Time Part Time Temporary
How did you hear about ICEE?
Have you ever applied with our company before?	Yes No
When?	For what position?
Please describe any experiences, skills or qualifications which you fill would especially qualify you for work with our company:

May we contact your present employer?	Yes No
How soon will you be able to work?
What starting salary range do you consider appropriate?

Education & Training
	Name of School	City & State	Major Course	No. of yrs.	Degree
High School
Business/Trade School
College
Others (describe)
Others (describe)
Are you planning to pursue further studies? Yes No	If so, when?

List most recent employment first; include all positions with each employer. This section must be completed even if a resume is attached.

Employment History
From	Company/Business	Title of Position
To	Address	Duties (including supervision)
Type of business		Supervisor's Name
Final Pay Rate		Supervisor's Telephone No.
Reason for Leaving


From	Company/Business	Title of Position
To	Address	Duties (including supervision)
Type of business		Supervisor's Name
Final Pay Rate		Supervisor's Telephone No.
Reason for Leaving


From	Company/Business	Title of Position
To	Address	Duties (including supervision)
Type of business		Supervisor's Name
Final Pay Rate		Supervisor's Telephone No.
Reason for Leaving


From	Company/Business	Title of Position
To	Address	Duties (including supervision)
Type of business		Supervisor's Name
Final Pay Rate		Supervisor's Telephone No.
Reason for Leaving

General Information
References 1. List two references other than relatives, persons employed by this company and those for whom you have worked.
Name	Telephone		Years known
a		Friend Business Acquaintance
b		Friend Business Acquaintance
2. Relatives, including those by marriage, employed by this company.
Name		Relationship	Telephone
a.
b.
c.
3. Friends employed by this company.
Name		Years Known	Telephone
a.
b.

Do you have a valid driver's license with a clean driving record? (Only if applying for a position that requires driving Yes No		Please list any accidents/violations that have occurred in the past 3 years.


Have you ever been convicted of a felony? Yes No (A conviction of a felony does not automatically preclude you from consideration)		Please provide dates and describe.

Why do you want to work for the ICEE Company?

Remarks
List any additional details necessary to complete or clarify your application.

APPLICANT STATEMENT: The information given is true and correct and I understand that if I am employed, any misrepresentations, false statement or omission of consequence herein, found by the Company at any time, will be sufficient cause to terminate my employment. I also authorize the Company (except as otherwise noted) to obtain from others information believed by the Company to be pertinent to my employment.

I Accept I Don't Accept