We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status or any other legally protected status. PERSONAL DETAILS: *LAST NAME:  *FIRST NAME :  MIDDLE NAME :  *ADDRESS:  *CITY:  *STATE:  *ZIP:  *TELEPHONE:  CELLULER/BEEPER/OTHER:  EMAIL ADDRESS :  *SOCIAL SECURITY NUMBER :  DRIVERS LICENSE NUMBER IF DRIVING IS AN ESSENTIAL JOB FUNCTION:  DATE OF APPLICATION:  *POSITION APPLIED FOR:    *HOW DID YOU HEAR ABOUT US? PLEASE CHECK ALL THAT APPLY NY TIMES AD: NEWSDAY AD: GOVERNMENT AGENCY: WALK IN, CAME IN ON MY OWN: FRIEND:   NAME RELATIVE:   NAME EMPLOYEE:   NAME SCHOOL:   NAME OTHER:  Please check the type of work and shifts you are available for. Please remember that we are a 7-day, 24-hour operation and schedule restrictions may influence which positions you are eligible for. *FULL-TIME Yes   No   *PART-TIME Yes   No   *TEMPORARY Yes   No   *EDUCATIONAL/EXTERNSHIP Yes   No   *MORNINGS Yes   No *AFTERNOONS Yes   No *EVENINGS Yes   No *OVERNIGHTS Yes   No *MON-FRI Yes   No *SATURDAY Yes   No *SUNDAY Yes   No *HOLIDAYS Yes   No *DATE AVAILABLE TO START: *DESIRED SALARY RANGE $: *NOTE ANY RESTRICTIONS IN YOUR SCHEDULE:     Are you legally eligible for employment in this country? Proof of citizenship or immigration status will be required upon employment Yes   No Have you ever been convicted of a crime? Yes   No If yes, please provide date(s) and details Do any of your friends or relatives work here? Yes   No If yes, please state their names and relationship to you Have you worked here before? Yes   No If yes, from   To   Position   Have you submitted an application here before? Yes   No If yes, what position when did you apply Are you over 18 years of age? Yes   No If no, can you provide required proof of your eligibility to work Can you travel if your job requires it? Yes   No Will you work overtime if required? Yes   No If no, please explain. Are you currently employed? Yes   No If yes, may we contact your current employer? Are you currently on "lay-off" status and subject to recall? Yes   No Are you able to meet the attendance requirements of the position? Yes   No       EDUCATION (COMPLETE FOR LAST EDUCATIONAL INSTITUTION ATTENDED) NAME & ADDRESS OF HIGH SCHOOL:  COURSE:  YEARS COMPLETED:  DIPLOMA/DEGREE:  NAME & ADDRESS OF UNDERGRADUATE COLLEGE:  COURSE:  YEARS COMPLETED:  DIPLOMA/DEGREE:  NAME & ADDRESS OF GRADUATE/PROFESSIONAL:  COURSE:  YEARS COMPLETED:  DIPLOMA/DEGREE:  OTHERS:  COURSE:  YEARS COMPLETED:  DIPLOMA/DEGREE:  WORK EXPERIENCE START WITH YOUR PRESENT OR LAST JOB. INCLUDE ANY JOB RELATED MILITARY SERVICE ASSIGNMENTS AND VOLUNTEER ACTIVITIES. YOU MAY EXCLUDE ORGANIZATIONS WHICH INDICATE RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, DISABILITIES OR OTHER PROTECTED STATUS EMPLOYER:  ADDRESS:  TELEPHONE NO:  STARTING/PRESENT JOB TITLE:  SUPERVISOR:  DATES EMPLOYED FROM:   TO:    WORK PERFORMED:  HOURLY RATE/SALARY:   TO:    REASON FOR LEAVING (if applicable):  MAY WE CONTACT Yes   No   EMPLOYER:  ADDRESS:  TELEPHONE NO:  STARTING / PRESENT JOB TITLE:  SUPERVISOR:  DATES EMPLOYED FROM:   TO:    WORK PERFORMED:  HOURLY RATE/SALARY:   TO:    REASON FOR LEAVING (if applicable):  MAY WE CONTACT Yes   No   EMPLOYER:  ADDRESS:  TELEPHONE NO:  STARTING / PRESENT JOB TITLE:  SUPERVISOR:  DATES EMPLOYED FROM:   TO:    WORK PERFORMED:  HOURLY RATE/SALARY:   TO:    REASON FOR LEAVING (if applicable):  MAY WE CONTACT Yes   No EMPLOYER:  ADDRESS:  TELEPHONE NO :  STARTING / PRESENT JOB TITLE:  SUPERVISOR:  DATES EMPLOYED FROM:   TO:    WORK PERFORMED:  HOURLY RATE/SALARY:   TO:    REASON FOR LEAVING (if applicable):  MAY WE CONTACT Yes   No INCLUDE EXPLANATION OF ANY GAPS IN EMPLOYMENT   DESCRIBE ANY SPECIAL TRAINING, APPRENTICESHIP, SKILLS AND EXTRA-CURRICULAR ACTIVITIES.