Employment Application

APPLICANT INFORMATION

Last Name
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First
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MI
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Street Address
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Apartment/Unit #
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City
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State
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ZIP
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Phone
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Desired Salary
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Circle Desired: Full Time / Part Time
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How did you hear about us?
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Desired Position
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Means of Transportation
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Are you authorized to work in the U.S.?
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Have you ever worked for this company?
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Have you ever been convicted of a felony?
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Date available if hired
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If so, when?
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If yes, what for & when?
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Are you able to bend, stoop and twist repeatedly to complete tasks?
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Are you able to lift 30 pounds above your head?
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Are you able to lift, pull and push up to 80 pounds repeatedly?
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Are you able to stand for up to 6 hours at a time?
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Are you able to wear the following safety equipment: hard hat, safety glasses, hearing protection, work gloves and steel toe or composite toe footwear?
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EDUCATION

High School
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Location
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From
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To
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Did you graduate?
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GED?
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College
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Location
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From
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To
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Did you graduate?
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Degree
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Other
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Location
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From
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To
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Did you graduate?
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Degree
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MILITARY SERVICE

Branch
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From
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To
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All applicants are considered for employment without regard to race, color, national origin, religion, sex, age, marital or veteran status, or disability.

REFERENCES

Please list three professional (non-relative) references.

Full Name
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Company
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Relationship
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Phone
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Address
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Full Name
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Company
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Relationship
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Phone
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Address
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Full Name
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Company
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Relationship
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Phone
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Address
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PREVIOUS EMPLOYMENT (LIST MOST RECENT FIRST)

Company
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Address
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Phone
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Supervisor
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Job Title
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Starting Pay $
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Ending Pay $
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Responsibilities
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From
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To
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Reason for Leaving
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Company
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Address
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Phone
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Supervisor
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Job Title
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Starting Pay $
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Ending Pay $
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Responsibilities
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From
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To
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Reason for Leaving
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Responsibilities
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From
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To
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Reason for Leaving
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Company
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Address
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Phone
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Supervisor
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Job Title
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Starting Pay $
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Ending Pay $
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Responsibilities
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From
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To
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Reason for Leaving
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DISCLAIMER AND SIGNATURE

I certify that all of the information in this employment application is true and complete to the best of my knowledge, and I authorize investigation of all statements contained

Your Full Name
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Date
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