Name
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First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
*
(###)
###
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Phone
(###)
###
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Email
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Position for which you are applying
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Check the following options you would consider
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If part time, specify hours of availability
What is your minimum salary requirement?
Do you have any commitments to another employer that might affect your employment with us?
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List any previous names or aliases
*
Select your Highest Level of Completed Education
Name Of High School
High School Address (If Applicable)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Degree Received?
Name Of College
College Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Degree/Diploma Major Course of Study
Degree Received?
Graduate School (If Applicable)
First Name
Last Name
Graduate School Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Degree/Diploma Major Course of Study
Degree Received?
Trade School Name
Trade School Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Degree/Certification/Diploma/Major Course of Study
List any other education, training, special skills or certificates/licenses that you possess related to the job
Degree/Certification Received?
Professional License/Certification Type Issuing Agency Certificate #
Professional License/Certification Type
Issuing Agency
State Issued
Expiration Date
MM
DD
YYYY
Professional License/Certification Type Issuing Agency Certificate #
Professional License/Certification Type
Issuing Agency
State Issued
Expiration Date
MM
DD
YYYY
List any machines, equipment or software programs on which you are qualified and experienced in operating
List any languages that you speak fluently:
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List any languages that you Read/write fluently:
*
Do you have a valid driver’s license?
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Yes
No
Driver’s license in what state?
Driver’s license Class
Military experience?
If yes, what branch?
Rank at separation
Dropdown
Option 1
Option 2
Can you, after employment, submit verification of your legal right to work in the United States?
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Are you 16 years old or over? (If under 18, state age ___)
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Were you previously employed by us?
*
List any relatives working for us:
Can you perform the essential functions of the job?
*
If no, please explain:
How did you hear about us?
*
Most Recent Job Held Name of Employer
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Type of Business
Dates Employed (from – to)
Name and Title of Supervisor
May We Contact?
Phone
(###)
###
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Brief Description of Duties
Type of Employment
Reason for Leaving
Name of Employer
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Type of Business
Dates Employed (from – to)
Name and Title of Supervisor
May We Contact?
Phone
(###)
###
####
Brief Description of Duties
Type of Employment
Reason for Leaving
Name of Employer
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name and Title of Supervisor
Phone
(###)
###
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May We Contact?
Type of Employment
Brief Description of Duties
Reason for Leaving
Reference Name
*
First Name
Last Name
Occupation/Association
*
Phone
*
(###)
###
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Reference Name
First Name
Last Name
Occupation/Association
*
Phone
*
(###)
###
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Reference Name
*
First Name
Last Name
Phone
*
(###)
###
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Occupation/Association
*
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
ADDITIONAL INFORMATION
Please include any other information you think would be helpful to us in considering you for employment, such as additional work experience, articles/books
published, activities, honors received, etc. (You may omit all information that would indicate age, sex, sexual orientation, race, religion, color, national origin, or disability, or any information that may be protected by federal or state law)
APPLICANT INFORMATION TERMS AND CONDITIONS (PLEASE READ THE FOLLOWING STATEMENT CAREFULLY)
*
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.
If hired, I agree to abide by the employer’s policies and procedures which include the Anti-Harassment Policy. I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of the employer or myself. I further understand that no manager or representative of the employer, other than the president, has any authority to enter into any agreement, oral or written, on behalf of the employer for a term of employment or to make any assurance or promise of continued employment.
I hereby authorize the employer to thoroughly investigate my references, work record, education and other matters related to my suitability for employment unless otherwise specified above. I further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
I understand that is considered for employment, after an offer is extended but before finalized the following may be required:
• The employer may obtain a consumer and/or investigative consumer report for employment purposes that may include information as to my character, general reputation, personal characteristics, and mode of living, work experience and performance, along with reasons for termination of past employment. The report may also contain a records check of driving, criminal, credit, education, degrees, professional licenses and/or certification record depending on the position. By signing this application, I authorize the procurement of a consumer and/or investigative consumer report by the employer as part of the post offer but pre-employment background investigation and if hired, at any time during my employment. I also authorize any prior employer to provide references to the employer.
• I understand and agree that I may be required to take a drug and alcohol screening test on a post offer, pre-employment basis.. I hereby give my voluntary consent for a blood and/or urine sample to be collected from me and submitted for testing. I also consent to the release of the test result to the employer for its use. I understand that any positive drug or alcohol result may preclude my employment. Testing will include for marijuana.
• I understand that I may be asked about my criminal history on a post offer, pre-employment basis:
California Applicants: Excludes will be convictions for possession of small amounts of marijuana if such convictions are more than two years old; .any records expunged, annulled, sealed, or discharged under first-offender law; and any records of convictions as a juvenile.
ELECTRONIC SIGNATURE
First Name
Last Name
Date
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MM
DD
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