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Application for Employment

Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.

Ngày ______________

Last name ________________________ First name ________________ Middle name________

Street Address _________________________________________________________________

City _____________________ State _______ ZIP _______

Điện thoại ___________________________ Social Security ___________________________

Position applied for __________________________________________

How did you hear of this opening? __________________________________________

When can you start? _____________________ Desired Wage $______________

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) Yes/No

Are you looking for full-time employment? Yes/No

If no, what hours are you available? ______________

Are you willing to work swing shift? Yes/No

Are you willing to work graveyard? Yes/No

Have you ever been convicted of a felony? (This will not necessarily affect your application.) Yes/No

If yes, please describe conditions. __________________________________________________

School Name and Location Year Major Degree

High School ________________________________________ ______ ______ ______

College ___________________________________________ ______ ______ ______

College ___________________________________________ ______ ______ ______

Post-College _______________________________________ ______ ______ ______

Other Training ______________________________________ ______ ______ ______

In addition to your work history, are there other skills, qualifications, or experience that we should consider? ______________________________________________________________________________

Employment History (Start with most recent employer)

Company Name ________________________________________________________________

Address ____________________________________ Telephone _________________________

Date Started ___________ Starting Wage ____________ Starting Position ________________

Date Ended _____________ Ending Wage ____________ Ending Position ________________

Name of Supervisor ____________________________________

May we contact? Yes/No

Responsibilities _____________________________________________________________

Reason for leaving ______________________________________________________________

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