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Application
for Employment
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Personal
Information
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Name:
Last
First
Mid. Initial
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Social
Security Number:
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Address
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List
all cities in which you have lived during the last 5 years:
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Home telephone: (
)
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Message or work #: (
)
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Have
you ever worked under another name?
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Yes,
list name
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No
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Are
you over 18 years old?
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Yes
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No
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Driver's License #:
State:
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Position
Desired
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Type
of position desired:
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Salary
desired:
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Type
of Employment Desired:
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Full
Time
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Part
Time
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Internship
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Temporary
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Who
or what prompted you to apply to our company?
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If
yes, give date, place, offense and outcome.
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Education
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Name
and location
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Years
Completed
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Degree
& Date of Degree
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Major
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High
School
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College/University
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College/University
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Other
Training (Trade Schools, Military, etc.)
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Name
under which your degree was obtained:
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References
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Name/Title
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Daytime
Telephone
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Please
list 3 individuals who are technical or business references
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|
(
)
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(
)
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(
)
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We
do not discriminate in employment because of sex, age, race,
color, religion, marital status, national origin, ancestry,
disability, sexual orientation, or veteran status.
Application
for Employment (continued)
You
may attatch your resume in place of completing the work history
below. However, we request that you complete those sections
below that are not included in your resume such as your salary
history and reasons for leaving. Thank you for your
cooperation.
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Present
or Most Recent Employer:
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Telephone:
(
)
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Address:
Street
City
State
Zip Code
|
|
Supervisor's
Name:
|
Supervisor's
Title:
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Telephone:
(
)
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Your
last job title:
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Dates
of Employment: (Mo./Yr.)
From:
|
To:
|
|
Last
or current base salary:
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Target
Bonus:
|
Target
Commission:
|
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Present
or Most Recent Employer:
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Telephone:
(
)
|
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Address:
Street
City
State
Zip Code
|
|
Supervisor's
Name:
|
Supervisor's
Title:
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Telephone:
(
)
|
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Your
last job title:
|
Dates
of Employment: (Mo./Yr.)
From:
|
To:
|
|
Last
or current base salary:
|
Target
Bonus:
|
Target
Commission:
|
|
Present
or Most Recent Employer:
|
Telephone:
(
)
|
|
Address:
Street
City
State
Zip Code
|
|
Supervisor's
Name:
|
Supervisor's
Title:
|
Telephone:
(
)
|
|
Your
last job title:
|
Dates
of Employment: (Mo./Yr.)
From:
|
To:
|
|
Last
or current base salary:
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Target
Bonus:
|
Target
Commission:
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Please
list specific computer hardware and software experience/skills:
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I hereby certify that the preceding information, the information
on any resume I have submitted, and the information supplied during
the interview process is true, correct and complete to the best
of my knowledge. I understand that false or misleading information
or omissions on the application, resume and/or during the interview
process may disqualify me from further consideration for employment
or be grounds for immediate termination of employment, if I am hired.
I authorize _______________________________and/or its designees
to conduct a thorough investigation of the statements made on this
application, resume, or during the interview process, including
but not limited to my prior employment history, conviction history,
and educational background, and agree to cooperate in such investigation.
Also, I hereby release from all liability and responsibility all
persons or corporations requesting or supplying such information.
I further understand that, if I am hired by __________________________,
my employment is "at will" and that either ______________________or
I can terminate the employment relationship at any time, with or
without notice, and with or without cause.
Signature of Applicant: ____________________________________________________
Date: ___________________________'
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