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A clear understanding of your background and work history will help us to evaluate your qualifications for employment. Please answer each question completely.
* = required field
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Your Name *
Last Name
First
Initial
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Social Security No.
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Date * (MM/DD/YYYY)
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Permanent Address *
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City, State Zip *
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Telephone (xxx-xxx-xxxx) *
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Are you less than 18 years of age? If yes, a work permit may be required. *
Yes No
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If hired, can you provide proof of identity and legal authorization to work in the US? *
Yes No
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Other name(s) under which you have been previously employed or attended school:
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Have you ever applied to this organization before? *
Yes No
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If yes, give date and position applied for.
Date:
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Position:
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Have you ever been employed by this organization before? *
Yes No
If yes, give dates of employment. (MM/YY)
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to
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Are you available to work overtime, or flexible work schedule? *
Yes No
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Except for offenses pertaining to Marijuana more than two years ago, have you ever been convicted of a crime, felony, or misdemeanor, or are you out on bail or on your own recognizance pending trial for such offense? * Why do we ask this?
Yes No |
If yes, state location and description (an affirmative response or a conviction will not necessarily disqualify you from the position for which you have applied).
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Driving jobs only, has your driver's license been revoked or suspended in the last three years?
Yes No
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Can you operate a manual transmission?
Yes No
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Driver's License No.
Class:
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Have you ever been bonded in prior employment? *
Yes No
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If yes, last name(s) of employer(s):
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Have you ever been terminated or asked to resign? If yes, please briefly explain. *
Yes No
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In case of emergency, notify *
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Address (Street City, State, ZIP)*
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Telephone (xxx-xxx-xxxx) *
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Position desired or area of interest? *
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If other please specify.
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Second choice?
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Date Available * (MM/DD/YYYY)
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Type of employment you are seeking *
Full-time
Part-time
Temp
Summer
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Pay Expected *
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Shifts you can work *
Day
Swing
Night
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How were you referred to our company?
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Other Company
Agency
Employment Service
Employee
School
Self
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Name of referral source (if applicable)
Other
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High School
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College
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College
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Other (including GED)
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Honors or awards received
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Professional Certificates or licenses held
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Are you taking any educational courses presently?
Yes No
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If yes, what course(s) and where?
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In the space below, please provide any additional information you feel will assisst us in evaluating your qualifications for employment, including technical training/education (including acquired in any military service), community affiliations, professional registrations, memberships and scholastic awards, honors or special skills. (You may exclude affiliations that may indicate race, color, ancestry, sex, sexual orientation, disability, religion, age, national origin or any other protected classification).
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