209 Courtney Lane, Crane, MO 65633 – Phone (417) 723-5700 Store Hours: 7:00 AM – 8:00 PM • 7 Days a Week Position You Are Applying For* First Name Last Name Address* Street Address* Address Line 2 City State / Province / Region Zip / Postal Code Phone Email Address Eligible To Work in the US?* Eligible To Work in the US?* yes No Day & Hours Available* Highest Degree/Diploma * Special Skills or Training * Name, Address, and Phone Number of Previous Employer * How Long Did You Work There? * Have You Been Convicted Of a Felony? * Have You Been Convicted Of a Felony? * Yes No Are You Willing To Be Tested For Drug Use? * Are You Willing To Be Tested For Drug Use? * Yes No 7 + 12 = Submit