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APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer
Position(s) Applied for
Full Time
Part Time
Name
Social Sec. No.
LEAVE THIS BLANK
Shift Work
Street _____________________________________________ City ______________________ Zip ___________
Home Phone (___)______________ Bus. Phone (___)_______________ Drivers Lic.# ____________________
(If required for the position which you are applying for.)
Have you filed an application here before?
Yes
No
Have you ever been employed here before?
Yes
No
Are you on lay off and subject to recall?
Yes
No
Can you travel if job requires it?
Yes
No
Date available for work__________________________
What is your desired salary range?____________________
If you are under 18, and it is required, can you furnish a work permit?
Yes
No
If no, please explain:
__
Are you legally eligible for employment in this country?
Yes
No
Are you able to meet the attendance requirements of the position?
Yes
No
Will you work overtime?
Yes
No
How were you referred? ________________________________________________________________________________
List names of your friends or relatives, other than your spouse, who work here ____________________________
Have you ever pled “guilty” or “no contest” to, or been convicted of a crime?
(Conviction information will not necessarily exclude you from a position unless it’s job related.)
Yes
No
Explain _____________________________________________________________________________________________
EDUCATION
___________________________________________________________________________________________________
HIGH SCHOOL
Name ____________________________________________ Years Completed
1
2
3
4
Address __________________________________________ Diploma?
Yes
No
___________________________________________________________________________________________________
COLLEGE
Name ____________________________________________ Years Completed
1
2
3
4
Address __________________________________________ Diploma?
Yes
No
___________________________________________________________________________________________________
GRADUATE
Name ____________________________________________ Years Completed
1
2
3
4
Address __________________________________________ Diploma?
Yes
No