C-Chex - Job Application Ages 16 to 20 Alcohol and Tobacco Shoppers

Contact	P.O. Box 42 Avon, New York 14414 585-243-2660

Ages 16 to 20 Alcohol & Tobacco Shoppers
New York & Pennsylvania
Job Application

Name:	Male or Female
Date of Birth:
Home Address :
City: State: Zip:
School(s) attended/degree(s) earned:
Graduation Date
Home Phone Number:	Your Cell Number:
Your E-mail Address:	If 16 or 17, do you have working papers? Yes No
Valid NYS Drivers License? Yes No	Or a Learner's Permit Yes No
Do You Have a Vehicle? Yes No	How old do people usually think you look?
Height Weight Hair Color Eye Color
Schedule: Time Available to Work MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
What Interested You in This Position?
If under 18 have you talked to your parents about this application? Yes No