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Application
What type of position are you looking for?
sales management Business Development HR Admin Accounting
Other
How did you hear about us? Please be specific
Telephone number, Best number to reach you
Other number
Email Address
First Name
Middle Int.
Last Name
Nickname
Address
City
State
Zip Code
Are you a US Citizen?
Are you legally eligible for employment in the USA?
How many days after being notified that you are hired will you be able to report to work? days
Preferred start date:
EMPLOYMENT: List last employment first. Include summer or temporary jobs.
Most Recent
Employer Name
Address
State
Zip Code
Position Title/Duties Skills Dates Employed from when to when
Reason for leaving
Any misdemeanors or felonies in the past 10 years, please explain
Any DUI's or DWI's in the past 5 yrs, please explain
Any tickets or accidents in the past 5 yrs, please explain
Supervisor's Name:
Supervisor's Telephone:
Can we contact?
References (List Co-Workers, former supervisors, subordinates)
Co-Worker's Name:
Co-Worker's Telephone:
Can we contact?
Previous Employment
Employer Name
Address
State
Zip Code
Position Title/Duties Skills Dates Employed from when to when
Reason for leaving
Supervisor's Name:
Supervisor's Telephone:
Can we contact?
Co-Worker's Name:
Co-Worker's Telephone:
Can we contact?
Awards/Recognition: What year? Explain:
Have you ever been promoted? If so, from what to what and how quickly?
How many years of management experience do you have? years.
How many people have you managed?
Do you have a valid Driver's License?
What state?
Do you have valid auto insurance?
IF NECESSARY FOR THE JOB I AM ABLE TO:
Work (which shifts)?
Work overtime?
Work Saturdays?
I am seeking a temporary or permanent position.
I am available to work the following days. Check all that apply (Monday - Saturday)
Mon Tues Wed Thurs Fri Sat Sun
Typing speed wpm
List all Professional Licenses, Certifications or Registrations:
Languages
First language:
Other Languages (please list):
Education
Graduated High School?
College/University - How many years completed?
Major:
Degree if Applicable:
Business/Technical? If yes, explain
Post Graduate Studies? Explain
Post Graduate Degree?
MILITARY SERVICE
Duty/Specialized Training:
From when to when?
Were you discharged? If yes, explain:
 
Additional skills including supervision skills, other languages, or information regarding the career/occupation you wish to bring to the employer's attention:
 
If necessary for employment you may be required to: supply your birth certificate or other proof of authorization to work in the US, have a physical examination and/or a drug test, have a criminal and DMV background check, sign a conflict of interest agreement and abide by its terms.
 
Information to the applicant: As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.
 
Additional comments
 
 
Disclosure:
Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.
 
* I understand and agree to the information shown above. Yes   

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