Liebe Inc.
Job Application
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Location *
Name *
Address *
Street, City, State, Zip Code
Telephone *
Social Security Number *
If less than 18 years of age, do you have a work permit? *
If not a U.S. Citizen, do you have the right to remain permanently and work in the USA? *
Do you have a record of founded child or dependent adult abuser or have you ever been convicted of a crime other than a simple misdemeanor offense relating to motor vehicles and laws of the road under Chapter 321 or equivalent provisions, in this state or any other state? *
Position applied for: *
Shift you can work: *
Hours desired: *
How did you learn of this opening? *
Date you can start: *
Highest Grade Completed *
Name and Location of last school attended *
Vocational or trade training *
List 2 persons who know you well.  Do not include relatives or former employers.  (Name, Address, Phone, Years aquainted with you) *
List below your work experience, starting with your present or last placement of employment. (Dates employed, Name and address of Employer, Name of Supervisor, Positions held) *
May we contact your present employer at this time? *
Additional Comments/Information *
Employment Understanding (Read and sign--sign by typing your name and date at the end)  This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, Vietnam era veteran status, or on the basis of age or physical or mental disability unrelated to the ability to perform the work required.  No question on this application is intended to secure information to be used for such discrimination.  I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, along with permission to conduct an Iowa criminal history check, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information.  I consent to take the physical examination and such future physical examinations as may be required by this institution at such times and places as the institution shall designate.  I understand that an offer of employment may be contingent on passing the physical examination which relates to the essential duties I would be required to perform.  I understand that my employment is at will and that either party is free to terminate the employment relationship at any time without cause.  I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.  If employed I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment. *
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