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Applicant
Information
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Name:
Age:
(Last,
First, Middle) (Age
requirement 16 and up) |
Address:
(Street
Address, Apt. #, City, State, Zip) |
Phone Number:
Email Address:
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Date Available to Begin:
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Position Applied For:
Location Applied For:
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Are you a citizen of the United States?
Yes
No
If Yes, are you authorized to work in the United States?
Yes
No |
Have you ever worked for this company?
Yes
No
If Yes, when?
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Have you ever been convicted of a felony?
Yes
No
If Yes, explain:
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Please indicate the days you are available to work.
Subsequent to any job offer we will consider whether
a reasonable accommodation can be made.
Fri
Sat
Sun
Mon
Tues
Weds
Thur
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Education
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High School:
Address:
From:
To:
Did you graduate?
Yes
No Degree:
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College:
Address:
From:
To:
Did you graduate?
Yes
No Degree:
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Other:
Address:
From:
To:
Did you graduate?
Yes
No Degree:
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References
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Please list 3 professional references. |
1)
Full Name:
Relationship:
Company:
Phone:
Address:
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2)
Full Name:
Relationship:
Company:
Phone:
Address:
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3)
Full Name:
Relationship:
Company:
Phone:
Address:
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Previous
Employment
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Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason For Leaving:
May we contact your previous supervisor for a reference?
Yes
No |
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason For Leaving:
May we contact your previous supervisor for a reference?
Yes
No |
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
Ending Salary:
Responsibilities:
From:
To:
Reason For Leaving:
May we contact your previous supervisor for a reference?
Yes
No
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Military
Service
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Branch:
From:
To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
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Disclaimer
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I certify that my answers are true and complete to
the best of my knowledge. If this application leads
to my employment, I understand that false or misleading
information in my application or interview may result
in my release. |
I understand and agree to the following:
All Holidays are required workdays.
There is a 90 day probation period.
Training wage of $6.25 per hour will be paid to all
new employees.
Employees are required to work all normal business
hours.
It is required that time off be requested prior to
the 15th of the month before time is needed off.
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