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Date |
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PERSONAL/WORK HISTORY
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Applications are considered CONTRACT WORK POSTIONS without regard to race, color, religion, sex, national origin, age, marital or veteran status, or in the presence of a non-related medical condition or handicap.
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Name: |
Address: |
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City: |
State: |
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Zip Code: |
Mobile #: |
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Home #: |
Additional: |
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Fax: |
Email: |
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Are you a citizen of the United States of America? |
If no, can you provide work eligibility documents? |
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Are you a veteran of the U.S. Military service? |
Are you 18 years or older? |
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Type of employment: |
Position: |
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How did you hear about us? |
RESUME/REFERENCE ( attach Resume, References, and Salary requirements) |
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EMPLOYMENT EXPERIENCE:
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Start with your present job or last job. Include military assignments and other volunteer activities. Exclude organizational names which indicate race, color, religion, sex, or national origin.
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Employer 1: |
Address: |
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City: | State: |
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Zip: |
Phone #: |
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Supervisors Name: |
Job Title: |
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Reason for Leaving: | Dates of Employment: From |
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to
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Salary or Hourly Rate: |
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Employer 2: |
Address: |
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City: | State: |
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Zip: |
Phone #: |
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Supervisors Name: |
Job Title: |
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Reason for Leaving: | Dates of Employment: From |
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to
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Salary or Hourly Rate: |
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EDUCATION |
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Schools/Colleges Attended: |
# Years |
Year Grad. |
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INDIVIDUAL BACKGROUND; A "Yes" or "No" answer to any of the following questions is not an automatic bar to employment. |
Have you been convicted, or plead no contest, to a felony, misdemeanor, Driving While Intoxicated (DWI) or Driving Under the Influence (DUI) in the last 7 years? |
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If yes, please explain |
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Have you ever been required by law to register as a sexual offender? |
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If yes, please explain: |
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Do you have reliable transportation to and from work daily? |
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Describe any relevant qualifications for this job: (i.e. Painting, insulation, construction, machine operations, and customer service) |
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