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PERSONAL INFORMATION |
Last Name |
First Name |
Middle |
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Present Street Address |
City |
State |
Zip Code |
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Permanent Street Address |
City |
State |
Zip Code |
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Home Phone |
Work Phone |
Cell Phone |
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which of these phone numbers would you like to be contacted
during the daytime? |
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| Are you
18 years of age or older? |
| Are you prevented
from lawfully becoming employed in this country because of visa
or immigration status? |
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EMPLOYMENT DESIRED |
Position desired |
Date you can start |
/ hour
Salary Desired |
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Are you employed
now?
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If
so, may we inquire of your present employer?
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| Have
you ever applied to this company before? If yes, when?
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| Who
referred you to our company? |
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EDUCATION |
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Name and Location of School |
No. of years attended |
Did you graduate? |
Subjects studied |
| Grammar School |
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| High School |
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| College |
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| Trade or Business School |
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Subjects of special study or research work:
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Special skills: |
Activities (Civic, Athletic, etc):
(Exclude organizations, the name of which
indicates the race, creed, sex, age, marital status or nation of
origin of its members) |
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FORMER EMPLOYERS |
Date
(Month / Year) |
Name and address of employer |
Salary
(per hour) |
Position |
Reason for leaving |
From
To |
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From
To |
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From
To |
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From
To |
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REFERENCES |
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Give the names of three persons not related to
you, whom you have known at least one year. |
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Name: Phone:
Business:
Years
Known: |
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Name: Phone:
Business:
Years
Known: |
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Name: Phone:
Business:
Years
Known: |
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| In
case of emergency, notify: Name: Phone: |
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By clicking "Submit":
I certify that all the
information submitted by me on this application is true and
complete, and I understand that if any false information,
omissions, or misrepresentations are discovered, my application
may be rejected and, if I am employed, my employment may be
terminated at any time.
In consideration of my employment, I agree to conform to the
company's rules and regulations, and I agree that my employment
and compensation can be terminated, with or without cause, and
with or without notice, at any time, at either my or the
company's option. I also understand and agree that the
terms and conditions of my employment may be changed, with or
without cause, and with or without notice, at any time by the
company. I understand that no company representative,
other than it's president, and then only when in writing and
signed by the president, has any authority to enter into any
agreement for employment for any specific period of time, or to
make any agreement contrary to the foregoing.
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