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Job Application

Submitted by editor on Tue, 06/08/2010 - 01:41.

If you are interested in joining our staff, please fill out the entire application before clicking send. Thank you!

PERSONAL INFORMATION:

First Name: *

Middle Name:

Last Name: *

Street Address: *

City, State, Zip Code: *

Phone Number: *

Email Address: *

Are you eligible to work in the United States?: *

Yes

Are you over 18 years old?: *

Yes

If you are under age 18, do you have an employment/age certificate?:

Yes

Have you ever been convicted of or pleaded no contest to a felony within the last five years?: *

Yes

If yes, please explain:

POSITION and AVAILABILITY:

Position Applied For: *

Days and Hours Available: *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Select all that apply.

Hours Available: *

example: from 8 am to 5pm

What date are you available to start work?: *

EDUCATION:

Name and Address of School: *

Degree or Diploma Obtained and Graduation Date: *

Skills and Qualifications: Licenses, Skills, Training, Awards: *

EMPLOYMENT HISTORY:

Present or previous employer:

Employer:

Address:

Supervisor's Name:

Phone Number:

Email Address:

Your Position Title:

From:

Example: From May 15, 2008 to June 3, 2010.

Responsibilities:

Salary: $

Reason for Leaving:

Previous Position:

Employer:

Address:

Supervisor's Name:

Phone Number:

Email Address:

Your Position Title:

From:

Responsibilities:

Salary: $

Reason for Leaving:

May We Contact Your Present Employer?: *

Yes

REFERENCES:

Name/Title, Adress and Phone Number: *

Name at least three personal or professional references.

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above. By typing my name in the space below, I am acknowledging that it will be used as my electronic signature.

Electronic Signature: *

Please type your full name.

Date: *

Please fill out full date: (Example: June 10, 2010)

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