Give name, address and telephone number of three references who are not related and are not previous employers.
List below last three employers beginning with your present job.
In Case of Emergency Notify:
The essential functions of the position for which you have applied include:
Lifting 50 pounds
Standing on your feet for 8 hours
Getting on your knees to mop floor
Bending and twisting yur body
Controlling your bladder
Reaction to heat or cold
Creating Conversation with customers
Lifting arms over head
Operating a cash register
I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Furthre, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.