Name: |
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Street: |
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City: |
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State: |
Zip Code:
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Telephone: |
Pager/Mobile:
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| Position(s) applying for: |
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Referral Source: |
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| If necessary, best time to call you at home is:
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| May we contact you at work? |
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Yes
No |
| If yes, work number and best time to call: |
Number: |
Time:
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| If you are under 18 and it is required, can you furnish a work permit? |
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Yes
No |
| If no, please explain: |
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| Have you submitted an application here before? |
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Yes
No |
| If yes, give date(s) and positions: |
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| Are you legally eligible for employment in this country? |
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Yes
No |
| Date available for work: |
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| What is your desired salary range or rate of pay? |
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$
per
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| Type of employment desired: |
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| Will you travel if the job requires it? |
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Yes
No |
| If they have been explained to you, are you able to meet the attendance requirements of this position? |
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Yes
No
N/A |
| If no, please explain: |
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Driver’s license number required only if driving may be an essential function in the job for which you are applying: |
Number: |
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State: |
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Answering “Yes” to the following questions does not constitute an automatic bar from employment. Factors such as date of the offense, seriousness and nature of violation, rehabilitation, and position applied for will be taken into account. |
| Have you ever pled “guilty” or “no contest” to or been convicted of a crime? |
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Yes
No |
| If yes, please provide date(s) and details: |
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Educational Background: |
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| Former Employers (Last 10 Years) |
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| References - List 3 people not related to you that have known you for at least 1 year.
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| Person to notify in emergencies: |
| Name: |
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| Telephone: |
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| Relationship: |
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Notice To Applicants
We comply with the Americans With Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you will be required to complete a post-job offer medical history questionnaire. All entering employees will be subject to the same medical questionnaire and all information will be kept confidential and in separate files.
We are an Equal Employment Opportunity Employer. We adhere to a policy of making employment decisions without regard to race, color, sex, religion, national origin, handicap or marital status. We assure you that your opportunity for employment with this Employer depends solely upon your qualifications.
Please Read Statements Below**
I understand that, in accordance with Florida Statute 443.131(3)(a)(2), if hired, I will be placed on a 90-day probationary period. I further understand that if I am terminated for unsatisfactory work performance within the 90-day probationary period, the employer may seek to contest any unemployment benefit I might attempt to obtain as a result of my termination. As a matter of policy, if hired, nothing in this application implies that an employment contract exists. The Company employs all employees on an at-will basis.
I understand that I may be required to undergo blood and/or urinalysis screening for drug or alcohol use as part of the pre-employment process.
I agree to the terms above.
I certify that all information given on this employment application and answers given during oral interviews are true and correct.
I understand that falsification of any information given may subject me to immediate dismissal. |
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