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APPLICATION FOR EMPLOYMENT

 

 

DATE : ______________

 

Position(s) applied for  :________________________________________________________________________________________________

 

Social Security # ______- ___-______

 

Name :_______________________________________________________________________________________________________________

                 Last                                                                         First                                                      MI

 

Address :_____________________________________________________________________________________________________________

                   Number                                       Street                                                    City                                              State                   Zip

 

Home Phone : __________________________        Bussiness /Cell _______________________     Other Contact________________________

 

If under 18 years of age , can you furnish a work permit ? ___________ Yes      ____________ No

 

Do you have a valid drivers license ? _________ Yes   ___________ No

 

Have you filed an application here before ? _________ Yes   _________ No                     If yes give date ______________________________

 

Have you ever been employed here before ? _________ Yes _________No                      If yes give date ______________________________

 

Are you employed now? _____ Yes  ________ No            If yes may we contact your employer? ________Yes   ________No

 

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? _____ Yes   _____ No

(Proof of citizenship or immigration status may be required upon employment) 

 

On what date would you be available to work ? ______________

 

Are you available to work:        __________Full Time    ________Part Time     _________ Shift Work     _________Temporary 

 

Are you on layoff and subject to recall?   _________ Yes    _______No

 

Have your been convicted of a felony within the last 7 years ? ______ Yes   _______ No

(conviction will not necessarily disqualify applicant from employment.)

 

If Yes please explain: ___________________________________________________________________________________________________

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                                                                                 *********Employment Experience***********

 

1. Employer __________________________________________________________________   Phone:__________________________________

 

Address _______________________________________________________________________________________________________________

                Number               Street                                                                                                             City                            State             Zip

Supervisor ________________________________       

 

Dates Employed : From  _______________   To _______________                          Starting Wage ____________   Ending Wage_____________

 

Work Performed : _______________________________________________________________________________________________________

 

Job Title ________________________________________   Reason for Leaving ____________________________________________________

 

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2. Employer __________________________________________________________________ Phone:__________________________________

 

Address_______________________________________________________________________________________________________________   

                   Number                                           Street                                                                           City                             State             Zip

 

Supervisor ________________________________

 

Dates Employed : From _______________ To _______________                               Starting Wage ____________ Ending Wage_____________

 

Work Performed : _______________________________________________________________________________________________________

 

Job Title ________________________________________ Reason for Leaving ____________________________________________________

 

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3.Employer __________________________________________________________________Phone:__________________________________

 

Address _______________________________________________________________________________________________________________    

                 Number                                                                    Street                                                    City                                          State             Zip

 

Supervisor ________________________________

 

Dates Employed : From _______________ To _______________ Starting Wage ____________ Ending Wage_____________

 

Work Performed : _______________________________________________________________________________________________________

 

Job Title ________________________________________ Reason for Leaving ____________________________________________________

 

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Please summarize special skills and qualifications aquired from employment or other experience,____________________________________

 

_______________________________________________________________________________________________________________________

 

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***********Education***********

 

 

High School

 

Name __________________________________________  Years Completed (circle)  9       10      11     12     Diploma      Y          N

 

Specialized Training , Apprenticeship Skills Received _________________________________________________________________________

 

______________________________________________________________________________________________________________________

 

College / University

 

Name _________________________________________   Years Completed (circle)  1      2     3    4    +        Diploma or Degree      Y         N

 

Course of Study _______________________________________________________________________________________________________

 

Specialized Training , Apprenticeship Skills Received ________________________________________________________________________

 

_______________________________________________________________________________________________________________________

 

Graduate / Professional

 

Name _________________________________________ Years Completed  (circle)  1      2      3     4     +           Diploma or Degree     Y       N

 

Course of Study ________________________________________________________________________________________________________

 

Specialized Training , Apprenticeship Skills Received _________________________________________________________________________

 

_______________________________________________________________________________________________________________________

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*************Military************

 

 

 

Have you served in the US Armed Forces?  (circle)     Y         N        If  yes , what Branch ? ________   Date Entered_______ Discharged______

 

Honorably Discharged ?   Y     N  

 

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Please state names of family and/or friends working for us. _______________________________________________________________________

 

__________________________________________________________________________________________________________________________

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***********Signature*************

 

The information provided in this Application for Employment  is true , correct and complete . If you employ me, any misstatement or omission

 

of the fact on this application may result in my dismissal.

 

I understand that acceptance of an offer of employment creates no obligation upon you, the employer, to continue to employ me in the future.

 

 

______________________________________________________________________________                            ____________________________

  Signature                                                                                                                                                                         Date