LIST RESIDENCES for the last ten (10) years and give dates lived at each address *
IF PART TIME, PLEASE INDICATE YOUR AVAILABILITY *
HAVE YOU EVER BEEN CONVICTED OF A CRIME OTHER THAN A MINOR TRAFFIC VIOLATION? *
IF “YES”, PLEASE EXPLAIN **Do not include a crime which has been expunged, annulled, or sealed by a court. (The existence of a criminal conviction does not constitute automatic disqualification of employment)
If hired, you will be required to furnish proof that you are legally authorized to work in the United States.
CAN YOU FURNISH SUCH PROOF? *
HAVE YOU EVER BEEN EMPLOYED AT PROKEL?
DO YOU HAVE ANY RELATIVES WORKING FOR PROKEL? **Relatives will not be employed under the direct supervision of one another nor will they be placed in the same department, if in ProKel's opinion, this could result in potential conflict of interest. *
NAME & RELATIONSHIP OF RELATIVE EMPLOYED BY PROKEL
WHO OR WHAT LED YOU TO APPLY AT PROKEL? PLEASE SPECIFY IF OTHER *
IDENTIFY THE AGENCY, NEWSPAPER, SCHOOL OR EMPLOYEE