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APPLICANT INFORMATION
First Name:
*
Last Name:
*
Middle Initial:
Street Address:
*
City:
*
State:
*
Zip Code:
Phone:(Home)
Cell:
Email Address:
*
Date Available:
*
Desired Salary :$
*
Position Applied for:
*
-Choose One-
Fork Lift Operator (Full-Time)
Fork Lift Operator (Part-Time)
Inventory/Clerical
Special Project Merchandise Processor (Full-Time)
Special Project Merchandise Processor (Part-Time)
Management/Executive
Other
(If other please specify):
Are you a citizen of the United States?
*
Yes
No
If no , are you authorized to work in the U.S?
Yes
No
Have you ever worked for this company?
*
Yes
No
If so when
Have you ever been convicted of a felony?
*
Yes
No
If yes, explain:
EDUCATION:
High School:
*
Address:
*
From:
*
To:
*
Did you graduate?
*
Yes
No
Degree:
College:
*
Address:
*
From:
*
To:
*
Did you graduate?
*
Yes
No
Degree:
Other:
Address:
From:
To:
Did you graduate?
Yes
No
Degree:
REFERENCES:
(Please list three professional references)
1. Full Name:
*
Relationship:
*
Company:
*
Phone:
Address:
*
2. Full Name:
Relationship:
Company:
Phone:
Address:
3. Full Name:
Relationship:
Company:
Phone:
Address:
PREVIOUS EMPLOYMENT:
1. Company:
*
Phone:
Address:
*
Supervisor:
*
Job Title:
*
Starting Salary: $
*
Ending Salary: $
*
Responsibilities:
*
From:
*
To:
*
Reason for leaving:
*
May we contact your previous supervisor for a reference?
*
Yes
No
2. Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Responsibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for a reference?
Yes
No
3. Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary: $
Ending Salary: $
Responsibilities:
From:
To:
Reason for leaving:
May we contact your previous supervisor for a reference?
Yes
No
MILITARY SERVICE:
Branch:
From:
To:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
DISCLAIMER:
I certify that my answers are true and complete to the best of my knowledge.If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
*
Yes