Name
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First Name
Last Name
Today's Date
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MM
DD
YYYY
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
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(###)
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Position for which you are applying:
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Select all that apply
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Specify availability Mon-Sun
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What is your minimum salary expectation?
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Do you have any commitments to another employer that might affect your employment with us?
List any previous names.
High School/GED
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List name and city/state.
College
List name, city/state, and major course of study.
Graduate School and/or Trade School
List name, city/state, and field of study.
List any other education, training, special skills, or certifications that you possess related to this job.
List any machines equipment, or software program for which you are qualified and experienced in operating.
List any languages you speak, read, or write fluently.
Do you have a valid driver's license?
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Yes
No
Driver's license state
Military experience?
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Check all that apply.
Can you, after employment, submit verification of your legal right to work in the United States?
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Yes
No
Are you 18 years old or over?
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Yes
No
Were you previously employed by us?
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Yes
No
List any relatives working for us.
Can you perform the essential functions of this job?
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Yes
No
If no, please explain.
How did you hear about us?
Current/previous employer name and address
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Job title
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Name and title of supervisor
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Telephone number
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(###)
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May we contact?
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Yes
No
Type of employment
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Check all that apply
Brief description of duties
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Reason for leaving
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Previous employer name and address
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Job title
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Name and title of supervisor
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Telephone number
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(###)
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May we contact?
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Yes
No
Type of employment
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Check all that apply.
Brief description of duties
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Reason for leaving
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List three references.
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Include occupation, company, phone number, and email address.
Name of emergency contact
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First Name
Last Name
Telephone of emergency contact
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(###)
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Electronic Signature: Please review the following carefully:
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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 in order to be 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.
I understand that I may be asked about my criminal history on a post offer, pre-employment basis. California Applicants: Exclusions 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.
Today's Date
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MM
DD
YYYY
