Career Opportunities

Full Name*

Mailing Address

City

State

ZIP Code

Phone Number*

Email Address*

Desired Position

Are you eligible for employment in the US?

YesNo

GENERAL INFORMATION

Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation?

YesNo

Have you been convicted of any felonies other than minor traffic violations during the past seven years? (A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to perform in the position for which you are applying.)
YesNo

If yes, explain:

Name of College / University / Trade School Attended

Course of Study

Number of Years Completed

Did You Graduate?

YesNo

Degree of Diploma Earned

Name of High School Attended

Did You Graduate from High School?

YesNo

SKILLS

Please list any skills you have that are appropriate for the position you are applying for:

If required, will you work?

Rotating Shifts

YesNo

Overtime

YesNo

Saturdays

YesNo

Sundays

YesNo

Position applying for, be specific:

Salary Requirements:

Per hour

YesNo

Per month

YesNo

State fully why you believe you are qualified for this position:

INTERESTS/ACCOMPLISHMENTS: You may wish to list significant experience, interests & accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the position(s) you are seeking. Names or organizations designating religion, race, etc. need not be mentioned.

EMPLOYMENT HISTORY

Past / Current Employer #1

Company Name

Company Address

Supervisor Name

Company Phone Number

Dates of Employment

Salary at Beginning and End

Position Held

Reason for Leaving

Past / Current Employer #2

Company Name

Company Address

Supervisor Name

Company Phone Number

Dates of Employment

Salary at Beginning and End

Position Held

Reason for Leaving

Anything Else We Should Know?

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