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Position(s) applied for
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Date of application
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Name
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Alaska
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Arizona
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Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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Have you ever been employed here before?
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Are you eligible for employment in this country?
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(Proof of US Citizenship or Immigration Status will be required upon employment)
Date available for work
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Type of employment desired
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Full-Time
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Are you on layoff and subject to recall?
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Will you relocate if job requires it?
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Will you travel if job requires it?
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Are you able to meet the attendance requirements of the position?
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Will you work overtime if required?
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Have you ever been bonded?
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Have you been convicted of a felony in the last seven (7) years?
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No
(Such conviction may be relevant if job related, but does not bar you from employment)
If yes, please explain
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Qualifications
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Desired Pay
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Employment History
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Dates Employed From
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Dates Employed To
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Hourly Rate/Salary Starting
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Summarize the nature of the work performed and job responsibilities
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Comments
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Skills and Qualifications
Summarize any special training, skills, licenses, certificates and/or characteristics of yourself that may qualify you as being able to perform job-related functions for the position which you are applying
Skills and Qualifications
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Educational Background
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List last three (3) schools attended, starting with most recent.
B.
List number of years completed.
C.
Indicate degree or diploma earned, if any.
D.
Grade Point Average or Class Rank and
E.
Major and
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B. Years Completed
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References
List name and telephone number of three business/work references that are not related to you and are not previous supervisors. If not applicable, list three school or personal references that are not related to you.
References
References Name
References Phone
References Years Known
Consent
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I agree to the following:
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It is understood and agreed upon that any misrepresentations by me on this application will be sufficient cause for cancellation of this application and/or separation from the employer’s services if I have been employed.
I give the employer the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law.
This application is current only for sixty (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.
I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.
I understand it is this company’s policy not to refuse to hire a qualified individual with a disability because of this person’s need for an accommodation that would be required by the ADA.
Signature of Applicant
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Signature Date
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