Job Application

Your Name *

First Name

Last Name

Your Phone Number *

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Your Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you 18 years of age or older? *

Yes

No

Are you currently a student? *

Yes

No

Are you prevented from lawfully becoming employed in this country because of a Visa or immigration status? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

Are you employed now?

Yes

No

If you are currently employed, may we contact your present employer?

Yes

No

Have you ever applied to the Southport General Store before?

Yes

No

Company Phone Number *

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Company Phone Number

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Phone Number *

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Phone Number *

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Are you a Veteran?

Yes

No

Do you currently hold a valid driver's license? *

Yes

No

Do you have physical limitations to performing job duties?

Yes

No

Emergency Contact Phone Number *

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