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Employment Application

Looking for a job? Please fill out the application below, and provide the location you'd like to work for.

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All fields marked with an (*) asterisk are required.

PERSONAL INFORMATION

Name*

Present Address*

Permanent Address

Cell Phone*

Home Phone

Email Address*

Number of Hours Requested Per Week*

Date You Can Start*

Position You Are Applying For*

Date of Birth if under 18

Referral

EDUCATION

High School #1: Did You Graduate?

Yes

No

School Name

Degree/Area of Study

School Name

High School #2: Did You Graduate?

Yes

No

Degree/Area of Study

School Name

Degree/Area of Study

College #1: Did You Graduate?

Yes

No

School Name

Degree/Area of Study

College #2: Did You Graduate?

Yes

No

School Name

Degree/Area of Study

Trade/Other School: Did You Graduate?

Yes

No

School Name

Degree/Area of Study

EXTRACURRICULAR ACTIVITIES

Activities/Honors

Special Skills

EMPLOYMENT HISTORY

List employment starting with your most recent position. Please indicate if you were employed under another name.

Employer #1

Company Name

Address, City, State, Zip Code

Dates Worked

Position Held

Supervisor

Major Duties

Salary/Wage

Reason For Leaving

Employer #2

Company Name

Address, City, State, Zip Code

Dates Worked

Position Held

SupervisorSupervisor

Major Duties

Salary/Wage

Reason For Leaving

Employer #3

Company Name

Address, City, State, Zip Code

Dates Worked

Position Held

Supervisor

Major Duties

Salary/Wage

Reason For Leaving

BUSINESS / SCHOLASTIC REFERENCES

Reference #1

Name

Address

Professional Title

Work Phone

Years Known

Reference #2

Name

Address

Professional Title

Work Phone

Years Known

Reference #3

Name

Address

Professional Title

Work Phone

Years Known

LEGAL

Are you a U.S. Citizen? **

Yes

No

If No, do you have a legal right and necessary documents to work in the U.S.?

Yes

No

Were you ever discharged by any company? **

Yes

No

If Yes, give name of company (ies)

Have you ever been convicted of a crime other than a minor traffic violation? *

Yes

No

If yes, explain offense and final dispostion

Check the box: **

Signature*

Date*

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