Fussy Employment Application
Personal Information
First Name*
Last Name*
Address*
 
City*
State*
Zip*
Phone*
Email
Job Applied for
How did you learn of this opening?
Referred By
Date Available
List hours available to work per week:
Monday Tuesday Wednesday Thursday Friday
From To From To From To From To From To
Saturday Sunday
From To From To
Background / Other Information
Are you legally authorized to work in the United States?* Yes No
Can you perform the essential functions of the job for which you are applying with or without reasonable accommodation?* Yes No
If No, describe the functions that can not be performed. (refer to position description if necessary)
Do you have reliable transportation to work?* Yes No
Do you have any relative or friends currently working for Fussy?*
    If yes, state name and relationship
Yes No
Do you have a valid driver's license?* Yes No
Are you 18 years of age or older?*
    If no, Date of Birth
Yes No
mm-dd-yyyy format
Are you willing to submit to and pass a controlled substance test?* Yes No
Have you been convicted of or pleaded no contest to a felony within the last 5 years?* Yes No
If yes, describe the crime(s), state the nature of crime(s), when and where convicted and disposition of case.

*Required Fields