| Required
fields are in RED. |
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Today's Date:
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We
are committed to a policy of Equal Employment Opportunity and will
not discriminate on any legally recognized basis,including but not
limited to race, age, color, religion, sex, marital status, national
origin, citizenship, ancestry, physical or mental disability, veteran
status, or any other legally protected basis.
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| Last
Name:
First
Name:
Middle
Initial:
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| Street
Address:
Apt./Unit
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| City:
State:
Zip:
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| Phone:
E-Mail
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Referred
by:
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| Position
for which you are applying:
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| Date
you can start:
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Salary
Desired:
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Yes
No
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Are
you currently employed? |
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Yes, we may inquire of your present employer
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Yes
No
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Have
you ever applied to this company before? |
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If
yes, where?
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If
yes, when?
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Yes
No
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Are
you willing and able to work overtime? |
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Yes
No
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Do
you have United States military or Naval service? |
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If
so, what rank did you achieve?
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| Jobs
for which driving is a requirement: |
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Yes
No
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Do
you have a current, valid driver's license? |
| If
driving is a requirement of the job for which you are applying, continued
employment is contingent on your maintaining a current driver's license. |
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| Minors: |
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Yes
No
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Can
you produce the age/work certificate necessary to obtain employment? |
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| Right
to work: |
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Yes
No
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Are
you able, at the time of employment, to submit verification of your
legal right to work in the United States? |
| Verification
and completion of the I-9 Form must be submitted no later than three
business days after date of hire. |
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| Felony
conviction: |
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Yes
No
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Have
you ever been convicted of a felony which is related to the functions
or qualifications of the position for which you are applying? |
| Note:
This question does not apply to convictions which have been sealed or
expunged. A conviction record will not necessarily be a bar to employment.
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Educational
Background
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| Name
and location of school: |
Years
completed: |
Major
area of study: |
| High
School:
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| College:
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Trade,
business, graduate or technical school:
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Specialized technical
skills (ie. computer training/programming, equipment operation, special
tools or machines used):
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Work
Experience
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| List
below your last 4 employers, starting with your present or most recent
place of employment: |
| Employer
Name:
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Address:
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| From:
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To:
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Position:
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Salary:
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Name
of supervisor:
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Reason
for leaving:
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| Employer
Name:
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Address:
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| From:
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To:
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Position:
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Salary:
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Name
of supervisor:
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Reason
for leaving:
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| Employer
Name:
|
Address:
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| From:
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To:
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Position:
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Salary:
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Name
of supervisor:
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Reason
for leaving:
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| Employer
Name:
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Address:
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| From:
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To:
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Position:
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Salary:
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Name
of supervisor:
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Reason
for leaving:
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References
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Give
the names of three persons not related to you, whom you have known
at least three years.
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First
Name:
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Last
Name:
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Phone:
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| Address:
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Years
Known:
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First
Name:
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Last
Name:
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Phone:
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| Address:
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Years
Known:
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First
Name:
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Last
Name:
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Phone:
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| Address:
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Years
Known:
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Applicant's
Statement
|
| Checking
the following boxes will act as your electronic signature to this job
application. Please be sure to read and understand the statements before
sending the application. |
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In signing this application, I certify that all of the foregoing information
is a complete and accurate statement of the facts and understand that
if any misrepresentation, omission, or falsification be discovered,
it will constitute grounds for dismissal. |
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I hereby authorize you to conduct any investigation necessary concerning
any part of my background related to the position I am seeking. |
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I release all parties from any liability in connection with the provision
and use of such information. |
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This application is current for 60 days. At the conclusion of this time,
if I have not heard from the employer and still wish to be considered
for employment, it will be necessary to fill out a new application.
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I understand and agree that, if employed by this organization, I will
abide by its rules and regulations, which I understand are subject to
change. |
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I further understand that, if hired, my employment is for no definite
period of time and may be terminated by either party at any time. |
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