Employment Application Employment Application Updated June 2018 APPLICATION INFORMATIONName* First Last Preferred NameLocation applying for:*La CrosseSpartaPermanent Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Local Address (if different) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberEmail Address* Are you legally eligible for employment in the USA?YesNoAre you over 14?YesNoAre you over 16?YesNoAre you over 18?YesNoDo you have reliable transportation to / from work?Have you worked for Rudy's in the past? If yes, when?Do you have any relatives currently employed at Rudy's? If yes, please list name(s).Position Applied forExpected WageI would be able to report to work ____ days after being hiredPlease fill in the blank.Summer AvailabilityPlease select the shifts that you would be available to work. Leave unchecked if you are not available.Mondays Open to 4pm 4pm to Close Tuesdays Open to 4pm 4pm to Close Wednesdays Open to 4pm 4pm to Close Thursdays Open to 4pm 4pm to Close Fridays Open to 4pm 4pm to Close Saturdays Open to 4pm 4pm to Close Sundays Open to 4pm 4pm to Close What is the MINIMUM number of hours you want to work per week?What is the MAXIMUM number of hours you want to work per week?School Year Availability (if different than summer)Please select the shifts that you would be available to work. Leave unchecked if you are not available.Mondays Open to 4pm 4pm to Close Tuesdays Open to 4pm 4pm to Close Wednesdays Open to 4pm 4pm to Close Thursdays Open to 4pm 4pm to Close Fridays Open to 4pm 4pm to Close Saturdays Open to 4pm 4pm to Close Sundays Open to 4pm 4pm to Close What is the MINIMUM number of hours you want to work per week?What is the MAXIMUM number of hours you want to work per week?EDUCATIONHigh School Name & LocationYears Completed01234College Name & LocationYears Completed0123456789101112131415MilitaryMilitary ServiceYesNoEmploymentListCompany NameCompany AddressPositionDatesSupervisor's NameSupervisor's PhoneMay we contact them? Please add up to 3 previous employers. Click the (+) sign to add a new employer.REFERENCESListNamePhone NumberEmployer / Position Please add 3 non-family references. Click the (+) sign to add a new reference.TermsI certify that the information provided in this application is correct to the best of my knowledge. I understand that false information may be grounds for refusal to hire or termination of employment. I authorize any person or organization listed on this application to provide references regarding my previous employment and qualifications. In consideration for employment, I agree to abide by the rules and regulations of the company, which may be changed, withdrawn, added, or interpreted at any time , a the company's discretion, with or without prior notice to me. I acknowledge my employment may be terminated, or job offer withdrawn, at any time, with or without cause, and with or without prior notice. I acknowledge that I have been advised that this application will remain active for no more than 90 days from the date signed.Electronic Signature*Please type your name.Today's Date*EmailThis field is for validation purposes and should be left unchanged.