Ice Cream

Print and complete all information in each section in ink.

Store #/Location:
Dots provides an equal opportunity for employment to all applicants and associates. No person shall be discriminated against in employment because of any protected basis including the individual's race, religion, color, gender, age, national origin, disability or any other legally protected basis.

Today’s Date:

Name (Last) Street Address Home Phone Desired Position

(First) City Cell Phone Rate of Pay

(Middle) State & Zip Code Work Phone Date Available

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Full Time Tuesday Wednesday Thursday

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Part Time

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Referred By
Sunday

Seasonal/Temporary
School/College

Specify hours available
Monday Friday Saturday

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 Dots Website/Internet 
Walk-in No No

Other__________ Associate(name)________________________

Are you at least 16 years old? Are you at least 18 years old?

*If you are under 18, you will be required to provide any state required minor documents if employed with Dots.

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Yes Yes

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Federal law requires that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with laws, all offers of employment are subject to verification of eligibility to work in the U.S.

Employment History List your last 3 employers, beginning with your current, most recent position.
May we contact your current Employer?
Employer Address Phone Number Job Responsibilities Hire Date Reason for leaving Employer Address Phone Number Job Responsibilities Hire Date Reason for leaving Employer Address Phone Number Job Responsibilities Hire Date Reason for leaving Term Date Starting Position Last Position Supervisor Name Starting Salary Final Salary Title Term Date Starting Position Last Position Supervisor Name Starting Salary Final Salary Title Term Date Last Position Supervisor Name

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Starting Position

Yes

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No Starting Salary Final Salary Title

Professional/Educational