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DATE
/
Month
/
Day
Year
How did you hear about us?
Personal Information
Full Name
*
First Name
Last Name
E-mail
*
Home Phone Number
-
Area Code
Phone Number
Mobile Phone Number
-
Area Code
Phone Number
Address
Are you legaly able to work in the U.S.A
*
Yes
No
Are you 18 or older?
yes
no
D.O.B
*
Driver License
*
Yes
No
Do You have a clean driving record? That means No accidents or tickets for the past 3 yrs.
*
Yes
No
Have you ever been convicted of a felony or misdemeanor?
*
Yes
No
Please describe any convictions:
Are you able to lift at least 35 lbs.
*
Yes
No
Can you stand for long periods of time
*
Yes
No
Employment Information
Applying for Position:
Do you speak or understand any other language? Explain
Position Desired. Please Check One
*
Temporary/On-Call
Part time
Full Time
When can you start?
/
Month
/
Day
Year
Salary Requirements
Shifts Prefered
*
Morning
Swing
Night
Any Shift
Transportation
*
I take public transportation to work
I receive rides from friends/family
I own my own vehicle
Why would you like to work for our company?
What behaviors are needed to be succesful in this industry?
Training Background
Discribe any Military Service
Security License #
*
Firearm Permit #
Batton Permit #
Chemical Agents Permit
*
Yes
No
First Aid/CPR
*
Yes
No
PC 832 Certificate
*
Yes
No
Mandatory 40hrs Training
*
Yes
No
Please describe additional training or experience
Please describe any computers skills.
Former Employers
Please fill out completely your past employers information. If you do not have the information, please look it up online. Please describe any gaps in your employment history at the end of list of past employers
Employer 1.
From:
/
Month
/
Day
Year
To:
/
Month
/
Day
Year
Name, Address and Phone number of employeer
Pay Rate
Position
Duties Performed
Reason for Leaving
Employer 2.
From:
/
Month
/
Day
Year
To:
/
Month
/
Day
Year
Name, Address and Phone number of employeer
Pay Rate
Position
Duties Performed
Reason for Leaving
Employer 3.
From:
/
Month
/
Day
Year
To:
/
Month
/
Day
Year
Name, Address and Phone number of employeer
Pay Rate
Position
Duties Performed
Reason for Leaving
Employer 4.
From:
/
Month
/
Day
Year
To:
/
Month
/
Day
Year
Name, Address and Phone number of employeer
Pay Rate
Position
Duties Performed
Reason for Leaving
Gaps in Employment History
Please describe any gaps in your employment history. Unexplained employment gaps will make your application incomplete
Personal References
Please list three personal references that are not past employeers
Name, Contact Information, Relationship, Years Known
Name, Contact Information, Relationship, Years Known
Name, Contact Information, Relationship, Years Known
Education
High School Graduate
*
yes
no
High School name and address
College/Trade School
Some College
College Grad
Post Grad Degree
Other/Trade School
College/Trade School Adress
Degree/ Skills
Signature or Initials
*
Date
/
Month
/
Day
Year
Submit
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