Application for Employment
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First Name
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Last Name
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MI
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Address
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State
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Zip Code
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City
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Phone No.
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Have you been convicted of a crime within the last 5 years?
(Conviction will not necessarily disqualify from employment)
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Yes
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No
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If yes, please explain:
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Are you at least 18 years of age and lawfully entitled to be
employed in the United States?
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Yes
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No
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__________________________________________________________
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Employment Desired
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Position
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Date you can start
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Do you have a valid driver's license?
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Yes
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No
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If yes, Driver's License Number
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State Issued
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__________________________________________________________
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Education
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No. of Years
Attended
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Did You
Graduate?
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Name
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Elementary School
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High School
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College
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Specialized
Training/Skills,
Subjects Studied
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__________________________________________________________
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Employment History
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Employer 1.
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Phone No.
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Address
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Date Started
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Date Ended
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Job Description
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Reason Left
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__________________________________________________________
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Phone No.
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Employer 2.
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Address
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Date Started
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Date Ended
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Job Description
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Reason Left
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__________________________________________________________
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Phone No.
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Employer 3.
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Address
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Date Started
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Date Ended
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Job Description
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Reason Left
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Applicant's Certification Agreement
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1. I authorize the investigation of all statements contained in this application and release from all liability any person
or employers supplying such information, and I also release the company from all liability that might result from
making the investigation.
2. I certify that the facts and information set forth in this application are true and complete to the best of my
knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application will be
cause for denial of employment or immediate discipline, up to and including termination of employment, regardless
of when or how discovered.
3. I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations
and I understand that the Company reserves the right to change policies, title, job description, wages, hours, and
working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL
BE AT-WILL, MEANING THAT EITHER PARTY CAN END EMPLOYMENT RELATIONSHIP AT ANY TIME
AND FOR ANY OR NO REASON.
4. I have read and reviewed the information provided in this application and the above statements. By submitting
this application for employment I certify that I understand all parts of it and have answered all questions completely
and fully.
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