| What Position are You Applying For: |
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| Name: |
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| Address: |
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| City, State and Zip Code: |
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| Telephone: |
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| Email Address: |
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| Date of Application: |
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| Objective: Please state your employment objective and wage requirements: |
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| Education (if more space is needed use back of application) |
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| High School:
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| Graduation Date:
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| Type of Course: |
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| Grade Average: |
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| Activities/Sports/Clubs: |
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College Secondary/Education/Specialized Training:
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| Graduation Date: |
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| Program: |
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| Degree Obtained: |
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| Cumulative GPA: |
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| Honors: |
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| Activities/Sports/Clubs: |
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| Work Experience: (Please list all current and former employment information for the last 10 years minimum. Do not skip over an employment no matter how short).. |
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| Position Held: |
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| Company: |
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| Address: |
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| Immediate Supervisor: |
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| Phone: |
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| Wage: |
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| Date of Hire: |
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| Date of Employment Ended: |
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| Reason for Leaving: |
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| Position Held: |
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| Company: |
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| Address: |
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| Immediate Supervisor: |
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| Wage: |
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| Date of Hire: |
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| Date of Employment Ended: |
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| Reason for Leaving: |
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| Position Held: |
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| Company: |
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| Address: |
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| Immediate Supervisor: |
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| Phone: |
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| Wage: |
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| Date of Hire: |
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| Date of Employment Ended: |
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| Reason for Leaving: |
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| Position Held: |
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| Company: |
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| Address: |
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| Immediate Supervisor: |
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| Phone: |
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| Wage: |
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| Date of Hire: |
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| Date of Employment Ended: |
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| Reason for Leaving: |
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| Our Licensure requires that we do not hire people with certain types of criminal records. Do you have a criminal record which may invalidate your application? |
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| Do you any physical disabilites for which we would need to make resonable accommodations? |
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| What shifts are not available for work: |
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| Do you have reliable transportation: |
Yes
No |
| What type of vehicle do you drive: |
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| Are you willing to testify againist the subjects of your investigation in open court: |
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Yes
No |
| Do you have any type of self-defense experience:
Yes
No |
| If so, what type:
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| Cite one example of where you had to work without close supervision, your responsibilities, and the result of this work: |
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| Since the job sometimes requires physical exertion, please cite examples of your current and past physical activities, hobbies, etc: |
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| Cite one specific example of a time you exhibited leadership qualities (on the job, at school, during leisure time, etc.) |
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