Full Name *
Email Address *
Phone Number *
Street Address *
City *
State *
Zip *
Are you over 18 years of age? *
---- Yes No
Why do you want to work at The Fireside? *
Position Desired *
Start Date *
Days and Hours Available *
School Name *
Grade Completed *
---- 8 9 10 11 12
High School Graduate *
---- Yes No Not Yet
College Name
Year Complete
---- Freshmen Sophomore Junior Senior
College Graduate
---- Yes No Not Yet
Past Work Experience #1 (include business name, contact, position, business address, business phone, length of employment & reason for leaving): *
Past Work Experience #2 (include business name, contact, position, business address, business phone, length of employment & reason for leaving):
Reference #1 (name & phone number): *
Reference #2 (name & phone number): *
Emergency Contact Name and Phone Number *
Due to the extreme increase in business between Memorial Weekend and Labor Day Weekend it is imperative we build a team that is committed to being available during this time frame. Do you have a conflict any weekends below: *
If you have conflicts with any of these dates, or if you have any vacations/trips planned for this summer, please explain:
Leave this field blank