KClinger's Employment Application (short version)
Please fill in all information.
 First Name:    MI:    Last Name:  
 Street Address:  
 City:    State:    Zip:  
 Phone Number:    7171234567
 Date of Birth:   /   /  yyyy
 Are you a US citizen?  Yes No
 What position are you applying for: 
 Date available:   Location: Publik House Tavern