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Employment Application

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									Employment Application
BACKGROUND Full Name: ______________________________ Address: ________________________________ ________________________________ Phone Number: ___________________________ Social Security Number: ___________________ Are you legally entitled to work in the United States? [ ] Yes [ ] No Are you 18 years old or older? [ ] Yes [ ] No If not, please give your date of birth: ______________________ What position are you applying for? ______________________________________ If you are hired, when can you start work? _______________ *****************************************************************

EDUCATION High School Name of School: __________________________ Location: ______________________ Number of years attended: _____________ Did you graduate? [ ] Yes [ ] No Date of graduation:_______________ Trade School Name of School: ______________________ Location: ______________________ Number of years attended: __________

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Did you graduate? [ ] Yes [ ] No Date of graduation:_________________ College Name of School: ______________________ Location: ________________________ Number of years attended: _____________ Did you graduate? [ ] Yes [ ] No Date of graduation:________________ What degree did you earn? __________________________ Graduate Name of School: ________________________ Location: __________________ Number of years attended: _____________ Did you graduate? [ ] Yes [ ] No Date of graduation:________________ What degree did you earn? _________________________ ******************************************************************

EMPLOYMENT HISTORY Beginning with your most recent employment and working back in time, please give the following information: Employer 1 Employer: ___________________________ Address: ____________________________ ____________________________ Telephone Number: _____________________ Job Title: ____________________________

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Duties: _____________________________ Dates of Employment: ________________ Supervisor: _________________________ Reason for Leaving: __________________ Employer 2 Employer: __________________________ Address: ___________________________ ___________________________ Telephone Number: ____________________ Job Title: _________________________ Duties: ____________________________ Dates of Employment: _________________ Supervisor: ___________________________ Reason for Leaving: ___________________ Employer 3 Employer: __________________________ Address: ___________________________ ___________________________ Telephone Number: ____________________ Job Title: ____________________________ Duties: _____________________________ Dates of Employment: _________________ Supervisor: __________________________ Reason for Leaving: ____________________

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PERSONAL REFERENCES Please provide the names of two references who have not employed you and are not related to you. Reference 1 Name: _____________________________ Address: ___________________________ ___________________________ Telephone Number: ______________________ Relationship: __________________________ Reference 2 Name: ____________________________ Address: ____________________________ ____________________________ Telephone Number: _______________________ Relationship: ___________________________ ******************************************************************

ADDITIONAL QUALIFICATIONS Please tell us about any other training, education, skills, or achievements that you feel should be considered. ___________________________________________________________________

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[ ] JOB DESCRIPTION Attached to this application is a complete job description. Please review it carefully. In the space provided below, please explain generally your ability to perform the listed duties. If you are called for a job interview, please be prepared to discuss this more fully at that time. ******************************************************************

My answers are true and complete. I understand that if I am hired, any false or incomplete statements in this application will be grounds for immediate discharge.

Date: _______________ Applicant's Name: ______________________

Applicant's Signature: __________________________________

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