Shirley’s Way Charitable Gaming Org#2527 Security Employment Application Applicants Full Name * First Name Last Name Date Of Birth * MM DD YYYY Home Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Number of hours per week desired? * Days desired? * Who referred you? Their phone number? (###) ### #### Have you worked with Shirleys Way before? * Yes No If yes when? MM DD YYYY Are you willing to work any shift, including nights and weekends? Yes No If no, please state your limitations If offered the job, when would you be able to start? * MM DD YYYY If hired, are you able to submit proof that you are legally able to work in the United States of America? * Yes No Have you previously work in gaming security? * Yes No Employment History List your current or most recent employment first. Employer Name 1 * Supervisors Name First Name Last Name Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Position Job duties? Reason for leaving? Date of employment MM DD YYYY Employer Name 2 * Supervisors Name First Name Last Name Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Position Job duties? Reason for leaving? Date of employment MM DD YYYY Additional employment history References Reference 1 * First Name Last Name Phone (###) ### #### Relationship to reference Reference 2 * First Name Last Name Phone (###) ### #### Relationship to reference Reference 3 * First Name Last Name Phone (###) ### #### Relationship to reference By clicking submit, you are authorizing Shirley's Way Way Charitable Gaming Org#2527 to use the data collected to perform a thorough review Applicants will have background checks per state of Kentucky Thank you! Someone from the Shirley’s Way team will be review the application. Become a $10 Monthly Donor
