Position(s) Applied For

Date of Application

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Last Name

 First Name

Milddle Name

How were you referred to us?

State

ZIP

Telephone:

Email:

Social Security Number

Can you provide proof of eligibility to work in the U.S and meet our age requirement of 18?

Yes No

Will you be able to complete the hours related to this position without tardiness or absenteeism?

Yes No

Have you ever submitted an application with us before?

If Yes, give date

Have you ever been employed by us or any of our affiliates before?

If so, what location?

Who was your supervisor?

During what dates?

Reason for leaving?

On what date would you be available for work?

Are you available to work:

Full Time

Part Time

Shift Work

Are you available to work:

AM Hours

PM Hours

Flexible

Can you travel if job requires it?

Yes

No

Have you ever been convicted of a felony?

Yes

No

If yes, please explain, as it may not exclude you from consideration

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List any up coming appointments or planned events that would not allow you to work a scheduled shift from your date of hire through the first 90 days of employment.

Date:

Appointment

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Education

Highest Level Completed:

9 10 11 12orGED

Degree?YesNo

Specify:

College degree?YesNoCredit Hours Completed

Workshops/Seminars

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Relative Employment Experience

From

To

Company

Position

Supervisor

Phone

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From

To

Company

Position

Supervisor

Phone

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From

To

Company

Position

Supervisor

Phone

List any special skills (i.e. Excel, Word, Ten Key):

Describe any special training you’ve received (i.e. United States Military, Trade School, etc.)

I certify that the answers given herein are true and complete to the best of my knowledge.  I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means the Employee may resign at any time and that the Employer may discharge Employee at any time without cause.  It is further understood that this “at will” employment relationship may be changed by written document or by conduct unless such change is specifically acknowledge in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations of the employer.

I understand that if hired, I am on probation as an employee for the first ninety days of my employment for the purpose of the Florida “Unemployment Compensation Law.”  If my employer should discharge me for unsatisfactory work performance during the first ninety days, they will not be held responsible for any benefits I might be determined eligible for in the future under “Unemployment Compensation Law.”

Date

By clicking the “Submit” button you attest that the information given is true and accurate. If upon hire the company discovers that the information given is untrue or inaccurate you are susceptible to termination and any future employment opportunities will be revoked.