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Application for Employment Position Applying

Today’s Date

For_____________________ Desired Wage ______________________

________________________ Date You Can

Start_________________________ Last Name___________________ First Name________________ Middle Name____________ Address______________________________________________________________________ _ Phone_______________________________

SSN_________________________________

Date of Birth ______________________

__ Sex _________

________________________ Race/Nationality ______________________________

Color

Religion

_______________________ Are You Pregnant Or Do You Plan on Getting Pregnant?________________________________ Are you Disabled? ____________ Please List All Disabilities_____________________________ ______________________________________________________________________________ Marital Status (Please Circle) Widowed Looking

Single

Married

Divorced

Hours Available Sunday

Monday

Tuesday

Wednes day

Thursda y

Friday

Saturda y

Employment History (For last three years. List most recent employer first) Previous Employer___________________________________ Address____________________________________________ Phone__________________

Immediate Supervisor

______________________________________ Dates Employed:

End_____________________

Start__________________ Starting

Ending

Wage__________________________ Reason For

Wage__________________________

Leaving_____________________________________________________________ May We Contact? Yes_____ No_____

Previous Employer___________________________________ Address____________________________________________ Phone___________________

Immediate Supervisor

________________________________ Dates Employed:

End_____________________

Start_________________ Starting Wage

Ending Wage

______________________ Reason For Leaving

________________________

____________________________________________________________ May We Contact? Yes_____ No_____ Previous Employer ____________________________________________________________ Address__________________________________________ Phone_____________________

Immediate Supervisor

_________________________________ Dates Employed:

End_____________________

Start_________________ Starting Wage _______________________ Reason For

Ending Wage ________________________

Leaving______________________________________________________________ May We Contact? Yes_____ No_____

Education Name of High School ___________________________________________________________ Address______________________________________________________________________ Highest Grade Completed ________ Did You Graduate?_______ Graduation Year________ Name of College or Technical School _______________________________________________ Address ______________________________________________________________________ Did You Graduate? ___________ Graduation Year__________ Degree Earned__________________________________________________________________

Please tell us anything else that will help you get the job: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

We reserve the right to hire or fire anyone based on race, color, sex, religion, sex, national origin, age, or disability status- or for any other reason.