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Action Cuts Employment Application
Employment Application
Email address *
Name *
Full Name: First, Middle, Last
Your answer
Date of Application *
Present Address *
Your answer
Telephone *
Please enter your 10 digit phone number included dashes. (xxx-xxx-xxxx)
Your answer
If under 18, please list current age:
Your answer
Position applied for *
Hourly pay desired *
Please be specific.
Your answer
Days available *
How many hours can you work weekly? *
Your answer
Can you work nights? *
Employment desired *
Educational History *
Please list all educational history, including a list of schools attended (name + address), # of years completed, and any major/degree.
Your answer
Have you ever been convicted of a crime? *
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
Your answer
Office Skills *
Please check any skills you have.
References *
Please list two references other than relatives or friends.
Your answer
Do you have a driver's license? *
What is your means of transportation to work? *
Please choose your main transportation to work.
License Type
Have you ever been in the Armed Forces?
Are you now a member of the National Guard?
Military History
Please list your specialty, date entered, and discharge date as appropriate.
Your answer
Work Experience *
Please provide a list of work experience from most recent to least recent for the last 5 years. Please include employer address, name of supervisor, dates of employment, salary, title, and reason for leaving.
Your answer
Additional Information
Please summarize any additional information necessary to describe your qualifications for the specific position you are applying for.
Your answer
May we contact your current employer? *
Did you complete this application yourself? *
A copy of your responses will be emailed to the address you provided.
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