Johnson's of St. Mary Employee Application Form Print, fill out, and mail this form to Johnson's of St. Mary, HC 72-10, Star Route, St. Mary, MT 59417-9701

Name:  ____________________________________   Social Security No:  __________________ Present Address:   ______________________________________________________________ Permanent Address:  ____________________________________________________________ Telephone:  _____________________      Date of Birth:  _________________     Height:  _______ Uniform Size:  _________  Health Status:  __________  Email Address:  ____________________ Please list any health problems:  ___________________________  Male/Female ____________ Position applied for:  ______________________   Will you accept another position?  ___________ Date available for work:  ____________________     Last day of work:  ______________________ Do you have use of a car?  ________       How would you arrive for work?  ____________________ Education (last year completed):  ___________________________________________________ List below your present and past employment history, including addresses and phone numbers of previous employers: (use additional paper if necessary) _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Please use the back of this form to tell us a little bit about yourself, and why you would like to work at Johnson's. How did you learn about Johnson's?   ______________________________________ List any friends or relatives who have worked for us:  ____________________________________ Person to be notified in case of emergency (name, address, and phone number): _____________________________________________________________________________ The facts set forth above in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. ________________________________________________         _________________________      Signature                                                                                                      Date