Application For Employment
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4APPLICATION FOR EMPLOYMENT
Please print or type all information except signature
Equal Opportunity Employer
Applicants for employment are considered without regard to race, religion, color,
Date
national origin, age, sex, disability, sexual orientation, or veteran’s status.
Position(s) Applied For:
Walk-in
Phonebook
Internet
Other (specify):
Referral Source
Referred by (name):
GENERAL INFORMATION
Name
Last
First
Middle
Address
Street
Apt #
City
State
Zip
Home Telephone
Social Security No.
Cell Phone
E-mail address
Have you ever submitted an application or been employed with our company?
Yes
No
Are you currently employed?
Yes
No
If yes, may we contact your employer?
Yes
No
Are you a United States citizen?
Yes
No
If no, do you have a valid work permit?
Yes
No
Proof of citizenship or immigration status will be required upon employment
/ hour
Employment desired:
Full-Time
Part-Time
Temporary
Desired Salary:
$
/ year
When can you begin employment?
Are you willing to travel if a job requires it?
Yes
No
If necessary, are you able to work overtime?
Yes
No
REFERENCES
Please list two references who are NOT relatives
Name
Name
Position
Position
Company
Company
Address
Address
Phone #
Phone #
Revised July 2010
ACF Corporation
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Parent category: Business