Employment Application
Email address *
Name *
Email *
Phone Number *
Social Security Number
Position Applied For
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Have you ever used another name?
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Is any additional information necessary to enable a check on your work and educational record, such as name change, nickname or use of assumed name?
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If yes, please explain:
Can you show proof that you are over eighteen years of age?
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Are you able, after employment, to present valid, current authorization to work in the United States?
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Have you ever been discharged from any position?
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If yes, please explain:
Please provide the names of any relatives already employed by our organization:
How were you referred to the company?
Have you ever been convicted in regard to any crime or offense (i.e. misdemeanor, felony, traffic violation, etc.) for which the record has not been sealed or expunged?
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Have you ever pled guilty in regard to any crime or offense for which the record has not been sealed or expunged?
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Have you ever received a suspended imposition of sentence in regard to any crime or offense for which the record has not been sealed or expunged?
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If yes to any of the 3 above questions, please briefly describe the nature of the offense(s)..the date and place of the conviction and the legal disposition of the case. This company will not deny employment to any applicant solely because the person has been convicted of an offense. The company, however, may consider the nature, date, and circumstances of the offense(s) as well as whether the offense is relevant to the duties of the position applied for.
Are you currently out on bail: the subject of a current warrant for arrest or released on your own recognizance pending trial? Answering yes will not necessarily be disqualifying.
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If your application receives favorable consideration, what salary/hourly rate would you require?
If your application receives favorable consideration, when will you be able to begin work?
Do you have any objection to working overtime?
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Can you work overtime without prior notice?
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Can you work Saturday if required by this position?
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Can you work Sunday if required by this position?
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Can you travel if required by this position?
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Full/Part Time?
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Highest Level of Education (School/Date Completed/Degree or Diploma)
Have you served in the U.S. Military?
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If yes, did your military service and training provide you with skills you could put to use in this job?
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If yes, please explain:
Please list any other skills, qualifications, education, training and the like that you possess that you believe may be helpful to you in performing the essential functions of the position applied for:
Current/Most Recent Employer:
Position held:
Manager/Supervisor:
Manager/ Supervisor Phone:
Dates Employed:
Wage/Salary:
Reason for leaving:
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