Personal Information

Name:
Social Security Number:
Permanent Address:
Permanent Phone Number:
Nantucket Address:
Nantucket Phone Number:
Email Address:
Are you over 21?	Yes No

Are you legally able to work in the U.S.A.?Yes No
Special Skills or Interests:

Employment Desired

Position Requested:
Date Available to Start:
Date Leaving Nantucket:
Do you have another job?	Yes No
Where?
Referred by:
Salary Desired:
Prefer to Work:	Days or Evenings

References

NAME	POSITION	ADDRESS	PHONE #

Work Experience

JOB TITLE	ESTABLISHMENT	DATES	SALARY	REASON FOR LEAVING

Additional Information We'd Find Helpful