Please submit this form at bottom of page or print and fax to (201) 998-8684
You may be asked to provide additional information after it is reviewed.

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Name: SS#: SS# Not required unless hired

Address:

City: State: Zip Code:

Phone: E-mail:

Are you legally eligible for employment in the United States? Yes OO No
(if yes, proof is required)

Are you of legal age to work in the United States? Yes OO No

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Position Applying For: Expected Pay $

Shift Preferred: 1st OO 2nd OO OO Any

Would you accept full-time work? Yes OO No

Would you accept part-time work? Yes OO No

Start Date:

Have you ever worked for Stewarts before? Yes OO No OO Date:

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EXPERIENCE/EDUCATION

HIGH SCHOOL:

Address:

City: State: Zip Code:

Did you graduate? Yes OO No

Course of Study: Degree:

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PREVIOUS EMPLOYMENT

1. EMPLOYER:

Address:

City: State: Zip Code:

Contact: Phone:

Dates Employed From: To:

Job Title:

Hourly Rate/Salary Starting: Final:

Work Performed:

Reason For Leaving:

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2. EMPLOYER:

Address:

City: State: Zip Code:

Contact: Phone:

Dates Employed From: To:

Job Title:

Hourly Rate/Salary Starting: Final:

Work Performed:

Reason For Leaving:

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I CERTIFY that the answers given herein are true and complete to the best of my knowledge. I understand that this application is not and is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given in my application or interview may result in termination. Signed:                                                                                                                      Date: