Application for Employment
Please fully and accurately complete each question.
Incomplete applications may not be considered.

Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, color, national origin, religion, age, sex, disability, or any other factor prohinited by law or regulation.
AN EQUAL OPPORTUNITY EMPLOYER


PERSONAL IDENTIFICATION

First Name

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Middle Name

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Last Name

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Phone Number

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Street Address

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City

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State

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Zip Code

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WORK PREFERENCE

Position Desired

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Salary or pay you expect

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Date avaliable to work

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List job benefits, other than wage, you expect or want in order of importance
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Describe your prior experience related to this work.

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Describe any formal schooling or training related to this work.

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List any licenses, certificates or professional affiliations you have.

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List any hobbies, special interests or sports that you are involved in.

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Are you applying for a driving position?

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FOR DRIVING JOBS ONLY

Do you have a valid drivers license?

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Class of License

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State

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Have you had your driver's license suspended or revoked in the last three years?

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If yes, give details

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AVAILABILITY FOR WORK

 
Type of Work (Check all that apply.) Invalid Input

Shifts or time of day (Check all that apply) Invalid Input

  Will you work daily overtime on accasion if necessary? Invalid Input

  Will you work extra days in the week if necessary Invalid Input

  Are you now or do you expect to be engaged in any other business employment or schooling? Invalid Input

  Do you have any commitments or agreements with another employer that might affect your employment? Invalid Input

  Do you have any on-going obligations or other personal commitments that would affect your work schedule? Invalid Input


PRESENT EMPLOYMENT

 
  Are you presently employed Invalid Input

  Do you have to give advanced notice to your present employer? Invalid Input

  May we contact your present employer for a reference? Invalid Input

PERSONAL

 
  If requested, would you be willing to take a drug/alcohol screening exam before and/or affter employment as a condition of employment? Invalid Input

  Are you at least 18 years old? Invalid Input

  If hired, can you furnish proff that you are authorized to work in the U.S.? Invalid Input


PRIOR EVENTS

 
  Have you ever worked for or applied for work at this company before? Invalid Input

  Have you ever been discharged for cause? Invalid Input

  Have you ever been refused a surety bond or ever had one cancelled? Invalid Input

  Have you ever been disciplined for absenteeism? Invalid Input

  Have you ever been convicted of any law violation, except or minor traffic violation? (A criminal record does not automatically bar employment) Invalid Input

  Have you ever been disciplined for tardiness? Invalid Input

Explanation to answers given above

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EDUCATION AND TRAINING

What is your highest grade or years of formal education? Invalid Input

Years of College or other Invalid Input

High School Name and Location

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Did you receive a High School Diploma?

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Grade Point Average

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Major Subjects

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Special Courses

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College or University Name and Location

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Attended from

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Attended to

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Did you receive a College Diploma?

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Grade Point Average

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Major Subject(s)

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Special Courses

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Graduate School Name and Location

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Attended from

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Attended to

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Did you receive a Diploma?

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Grade Point Average

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Major Subject(s)

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Special Courses

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Other Education - School Name and Location

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Attended from

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Attended to

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Did you receive a Diploma?

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Grade Point Average

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Major Subject(s)

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Special Courses

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EMPLOYMENT RECORD

1.Employer

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Address

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Phone

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Main Duties

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From

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To

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Starting Pay

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Leaving Pay

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Supervisor

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What did you like about this job?

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What did you dislike about this job?

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Reason for leaving

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2.Employer

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Address

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Phone

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Main Duties

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From

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To

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Starting Pay

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Leaving Pay

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Supervisor

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What did you like about this job?

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What did you dislike about this job?

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Reason for leaving

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3.Employer

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Address

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Phone

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Main Duties

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From

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To

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Starting Pay

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Leaving Pay

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Supervisor

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What did you like about this job?

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What did you dislike about this job?

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Reason for leaving

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4. Other postitions (including periods of military/public service)
Employer

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Main Duties

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From

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To

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Pay

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Reason for leaving

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Upload Resume

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APPLICANT AGREEMENT (Read carefully before signing.) All information provided by me is true and correct to the best of my knowledge. I understand omissions or misrepresentations may result in rejection of my application or, if employed, may result in subsequent dismissal. I hereby authorize any former employer, person, school, firm or corporation listed hereon, including this company, to answer any and all questions related to employment and agree to release from liability and hold all persons harmless for giving any and all truthful information within their knowledge or records. I understand this is a preliminary application and not a contract to employ me. Furthermore, in the event I am employed, my employment shall be completely voluntary and may be terminated at will at any time by either myself or the company. I understand that no one other than the company president has authority to enter into any employment agreement to the contrary. I agree to take a job related physical examination or a drug/alcohol test when requested as a condition of employment. I agree to comply with all rules of the company as a condition of employment. In the event the company advances me money or other things of value, I agree to repay the company and also that any amount still owing may be deducted from my final paycheck.
 
Applicant's Signature (*)

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