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    Personal Data


    Do you have a High School Diploma or GED? YesNo

    POSITION INFORMATION

    Check all that you are willing to work

    Hours:

    Full-timePart-time

    Shifts:

    DaysEveningSwingGraveyardWeekends

    Status:

    RegularTemporary

    Are you authorized to work in the U.S. on an unrestricted basis? YesNo

    Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) YesNo

    If yes, explain:

    Have you been told the essential functions of the job or have you viewed a copy of the job description listing the essential functions of the job?

    YesNo

    Can you perform these essential functions of the job with or without reasonable accommodation? YesNo

    QUALIFICATIONS

    Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges,
    degrees, vocational or technical programs, and military training.

    Educational Qualifications

    School name

    Degree

    Address/City/State

    School

    School

    Others

    SPECIAL SKILLS

    List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

    REFERENCES

    Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three
    professional references, then list personal, unrelated references.

    Name

    Address/City/State

    Phone

    Relationship

    WORK HISTORY

    Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)

    Start Date :

    End Date :

    May we contact your present employer? YesNoN/A

    I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am
    employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts
    set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.
    I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category
    employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

    Applicant Signature