Application - Allkleen2
Employment Opportunities
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Application
Employment Application
Programs, services and employment are equally available to everyone. Please inform the Human Resources if you require resonable accommodation for the application or interview.
DATE of Interview:______/______/________ Positon of: ________________________
.
Full Name:
Address
City:
State:
Zip:
Phone:
Cell:
Email:
Date Available to Start:
Social Security #:
Salary Reqt:
Under 18? Can you provide work permit?
Yes
No
If no, please explain:
Have you worked for this company?
Yes
No
If yes, when?
Are you legally allowed to work in the US?
Yes
No
Type of employment desired:
Full-Time
Part-Time
Temporary
Seasonal
Drivers License:
State:
Education History
Name & Location of High School:
Graduate?
Yes
No
Name & Location of College:
Years Attended:
Degrees completed:
Other Studies:
Trade, Business or Correspondence School:
Years Attended:
Subjects Studied:
Graduate?
Yes
No
Summarize Your Skills or Qualifications
Previous Employment (begin with most recent)
Date of Employment
From:
To:
Position Held:
Company Name:
Address:
City:
State:
Zip:
Phone:
Supervisor:
Title:
Responsibilities:
Starting Salary & Title:
Ending Salary & Title:
Reason for leaving:
May we contact employer:
Yes
No
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
Signature of Applicant
Date:
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