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Last Name First Middle Date
7/30/2014
Street Address Day Phone
City State Zip Evening Phone
Email Address Mobile Phone
Have you ever applied for employment with Us? Social Security Number
Yes: No: If Yes: Month Year
Position Desired Pay Expected
Apart from absence for religious observance, are you available for full-time work? Will you work overtime if asked?
Yes: No: If not, what hours can you work?
Are you legally eligible for employment in the United States? When will you be available to begin work?
Yes:

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School Name and Location Course Of Study #Years
Completed
Graduated Degree or Diploma
Graduate
College
Business
Trade
Technical
High School
Elementary

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Indicate any foreign languages you can speak, read, or write:
Fluent Good Fair
Speak
Read
Write

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Please give accurate, complete full-time and part-time employment records. Start with your present or most recent employer.

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Company Name Phone
Address Employed
From: To:
Supervisor Name Weekly Pay
Start: Finish:
Job Title and Description of work Performed Reason for Leaving

2

Company Name Phone
Address Employed
From: To:
Supervisor Name Weekly Pay
Start: Finish:
Job Title and Description of work Performed Reason for Leaving

3

Company Name Phone
Address Employed
From: To:
Supervisor Name Weekly Pay
Start: Finish:
Job Title and Description of work Performed Reason for Leaving

4

Company Name Phone
Address Employed
From: To:
Supervisor Name Weekly Pay
Start: Finish:
Job Title and Description of work Performed Reason for Leaving

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Did you serve in the U.S. Armed Forces? If Yes What Branch:
Describe any training received relevant to the position for which you are applying:



The information requested in this section is needed for a legally permissible reason, including, without limitation, national security considerations, a legitimate occupational qualification, or business necessity. The Civil Rights Act of 1964 prohibits discrimination in employement becuase of race, color, religion, sex, or national origin. Federal law aloso prohibits discrimination based on age and citizenship. The laws of most States also prohibit some or all of the above types of discrimination as well as some additional types such as discrimination based upon ancestry, marital status, or physical or mental handicap or disability.

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What was your previous address?
How long at previous address? How long at current address?
Are you over 18 years of age? Are you a U.S. Citizen?
Have you been convicted of a felony within the last seven (7) years?
If yes, describe in full:
Are you capable of performing the essential physical functions of the position you are applying for with or without reasonable accomodations?
Please describe any necessary accomodations needed to perform the essential functions:

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Describe any job-related specialized training, apprenticeship, skills, and extra-curricular activities:

SPECIALIZED SKILLS

Outlook Email Typewriter Access PC Oracle
Excel Fax Word

By clicking 'Submit", I agree that :

  1. The information provided in this Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal.
  2. I undeststand that acceptance of an offer of employment does not create a contractual obligation upon my employer to continue to employ me in the future.