Name:     

Address: 

 City:        

 State:      

 Zip:         

 10 Digit phone number: 

Email Address

 Are you 18 or older?      Yes    No

 If you are not 18, when is your birthday?  

 Have you ever been employed at McDonald's®? Yes   No

 If yes, what were your dates of employment? 

 If yes, what McDonald's® location did you work at? 

 Reasons for leaving McDonald's®:   

 School most recently attended:  

 Location: 

 School Phone Number: 

 Did you graduate from that school?   Yes   No

 Are you currently enrolled in that school?  Yes    No

 What was your last grade completed?  

May we contact your present employer?  Yes  No

 What was your most recent job? 

 Phone number: 

 Location: 

 Supervisor: 

 Dates worked:  

 Salary: 

 Job Description:  

 Reason for leaving your last job: 

 DURING THE PAST 5 YEARS, HAVE YOU EVER

 BEEN CONVICTED OF, PLED GUILTY TO, OR PLED

 NO CONTEST TO A CRIME, EXCLUDING                    Yes    No

MISDEMEANORS AND TRAFFIC VIOLATIONS?

 If yes, describe in full:  

ARE YOU OR HAVE YOU EVER BEEN A SEX

OFFENDER REGISTERED WITH ANY FEDERAL,

STATE, OR LOCAL GOVERNMENT AGENCY,                  Yes    No

INCLUDING ANY LISTING ON A PUBLIC WEB SITE?  

Were you referred?  Yes     No

Referred by:

Date available to start work:

                                                                                                      Hours:

What are your hours of availability?        Monday                   

                                                                    Tuesday                   

                                                                    Wednesday             

                                                                    Thursday                 

                                                                    Friday                      

                                                                    Saturday                  

                                                                    Sunday                              

 Are you applying for Management?  Yes   No

 Which restaurant are you applying for?  Beaver Dam Kentucky Brandenburg Kentucky Central City Kentucky Greenville Kentucky Hardinsburg Kentucky Leitchfield Kentucky Leitchfield Wal-Mart Kentucky Morgantown Kentucky

I understand that I am applying in the state of Kentucky, and have the intention of working in/ moving to that state Yes No

I acknowledge that the above information is correct and accurate Yes  No

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