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Venture

Date

PERSONAL/WORK HISTORY

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.

Name: Address:
City: State:
Zip Code: Mobile #:
Home #: Additional:
Fax: Email:
Are you a citizen of the United States of America? If no, can you provide work eligibility documents?
Are you a veteran of the U.S. Military service? Are you 18 years or older?
Type of employment: Position:
How did you hear about us? RESUME/REFERENCE ( attach Resume, References, and Salary requirements)

EMPLOYMENT EXPERIENCE:

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.

Employer 1: Address:
City: State:
Zip: Phone #:
Supervisors Name: Job Title:
Reason for Leaving:Dates of Employment: From
to
Salary or Hourly Rate:  


 
Employer 2: Address:
City: State:
Zip: Phone #:
Supervisors Name: Job Title:
Reason for Leaving:Dates of Employment: From
to
Salary or Hourly Rate:  


 

EDUCATION

  
Schools/Colleges Attended: # Years Year Grad.
  
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?
If yes, please explain
Have you ever been required by law to register as a sexual offender?
If yes, please explain:
Do you have reliable transportation to and from work daily?
Describe any relevant qualifications for this job: (i.e. Painting, insulation, construction, machine operations, and customer service)

EQUAL EMPLOYMENT OPPORTUNITY DATA Important
I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination.
Signature: Date:
Office personnel only:
Start date: Position:
Initial that application is complete: Additional notes: