Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a citizen of United States? *

Yes

No

If non-citizen, are you authorized to work in the United States?

Yes

No

Can you speak and write in English? *

Yes

No

Are you currently RETIRED or ON DISABILITY? *

Yes

No

How will you report to the Laundromat? *

I have a vehicle and will be driving in myself

I have a vehicle but someone else will be dropping and picking me up

I DON'T have a vehicle but someone will be dropping and picking me up

I'm taking the bus

I'm walking

What shift do you desire? *

Shift 1 (Saturdays to Wednesdays, 10 AM to 3 PM)

Shift 2 (Thursdays and Fridays, 10 AM to 3 PM)

Shift 3 (Fridays to Tuesdays 6 PM to 8 PM)

Are you allergic to dust or lint? *

Yes

No