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Step 1 of 4 - Employment Application
Equal access to programs, services, and employment is available to all persons. Those applicant requiring reasonable accomodation to the application and/or interview process should notify a representative of the Human Resources Department.
General Information
Last Name:
First Name:
Middle Initial:
Social Security Number:
Street Address:
City:
State:
Zip:
Phone Number:
Mobile/Beeper/Other Number:
Email Address:
Position Applied for:
Referral Source
(please check box & name the source)
Walk-in
School
Employee
Job Fair
Advertisement
Staffing Agency
Website
Government Agency
Other
Personal Information
Best time to call at home?
AM
PM
May we contact you at work?
Yes
No
Work number:
Best time to call:
If you are under 18 and it is required, can you furnish a permit?
Yes
No
If no, please explain:
Have you submitted an application here before?
Yes
No
Please give dates & position:
Have you been employed here before?
Yes
No
If yes, please give dates & position
Are you legally eligible for employment in this country ?
Yes
No
Date available to start work?
What is your desired salary range or hourly rate of pay?
Type of employment desired:
Educational Co-Op
Full-Time
Part-Time
Seasonal
Temporary
Will you relocate if job requires it?
Yes
No
Will you travel if job requires it?
Yes
No
If they have been explained to you, are you able to meet the attendance requirements of the position?
Yes
No
Will you work overtime if required?
Yes
No
If no, please explain:
Driver's License Number required if driving maybe required in the job for which you are applying:
License Number:
State:
Have you ever been bonded?
Yes
No
Answering "yes" to the following question does not constitute an automatic bar to emplyment. Factors such as date of the offense, seriouness and nature of the violation, rehabilitation and position applied for will be taken into account.
Have you ever plead "guilty" or "no contest" to, or been convicted of a crime?
Yes
No
If yes, please provide dates & details
