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Employment Opportunities
Please fill out this form completely and correctly to be considered
for any current or future job openings.
First Name:
Middle Initial:
Last Name:
Street Address:
City:
State:
ZIP Code:
Telephone:
Alternate Telephone:
E-mail:
Primary position applied for:
Type of employment desired:
(NOTE: choose one.)
Full-time
Part-time
Temporary
Seasonal Employment History:
Employer #1:
Address:
Telephone:
Dates employed:
Please include your starting job title/final job title, supervisor & title,
starting salary/final salary, reason for leaving, and summarize the type of work
performed as well as job responsibilities.
May we contact for reference?
YES
NO
Employer #2:
Address:
Telephone:
Dates employed:
Please include your starting job title/final job title, supervisor & title,
starting salary/final salary, reason for leaving, and summarize the type of work
performed as well as job responsibilities.
May we contact for reference?
YES
NO
Employer #3:
Address:
Telephone:
Dates employed:
Please include your starting job title/final job title, supervisor & title,
starting salary/final salary, reason for leaving, and summarize the type of work
performed as well as job responsibilities.
May we contact for reference?
YES
NO
Comments
including explanation of any gaps in employment.
Skills and Qualifications:
Summarize any special training, skills, licenses, and/or certificates
that may qualify you as being to perform job-related functions in the
position for which you are applying.
Computer
Skills (Check appropriate boxes. Include software titles and years of experience.)
Word Processing
Years
Spreadsheet
Years
Presentation
Years
E-mail
Years
Internet
Years
Other
Years
Other
Years
Educational
Background:
School #1:
Number of years completed:
Degree Diploma:
GPA Class Rank:
Major/Minor:
School #2:
Number of years completed:
Degree Diploma:
GPA Class Rank:
Major/Minor:
Applicant Statement:
I certify that all information I have
provided in order to apply for and secure work with the
employer is true, complete and correct.
I understand that any information provided by me that
is found to be false, incomplete or misrepresented in
any respect, will be sufficient cause to (1) cancel further
consideration of this application, or (2) immediately
discharge me from the employer's service, whenever it
is discovered.
Do not submit
form until you have read the above Applicant Statement.
By
submitting this form I certify that I have read, fully
understand and accept all terms of the foregoing Applicant
Statement.
