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Today's Date and Time
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May 18, 2012, 4:44 am |
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Personal Information
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First Name
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Last Name
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Email Address
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Present Address
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Present City
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Present State
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Present Zipcode
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Home Phone
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Cell Phone
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Employment Desired
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Position Desired
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Date you can start
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Salary Desired
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per
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Are you employed now?
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Yes
No
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If so, may we inquire of your present employer?
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Yes
No
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Are you legally authorized to work in the U.S.?
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Yes
No
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Have you applied to work with us before?
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Yes
No
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If so, where?
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And if so, when?
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Education History
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High School
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Did you graduate?
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Yes
No
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College Name
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Primary studies
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Did you graduate?
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Yes
No
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Trade School
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Primary studies
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Did you graduate?
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Yes
No
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General Information
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Special Training
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Special Skills
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U.S. Military History
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Former Employers
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Dates employed
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Name of employer
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Employer location
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Position
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Reason for leaving
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Dates employed
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Name of employer
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Employer location
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Position
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Reason for leaving
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Dates employed
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Name of employer
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Employer location
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Position
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Reason for leaving
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References (Three persons *not related to you* whom you have known for 1 year)
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Reference 1 Full Name
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Reference 1 Location
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Reference 1 Occupation
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Reference 1 Years Known
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Reference 2 Full Name
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Reference 2 Location
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Reference 2 Occupation
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Reference 2 Years Known
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Reference 3 Full Name
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Reference 3 Location
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Reference 3 Occupation
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Reference 3 Years Known
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Choose Your Stores
Choose which stores you would like your application to be sent to (choose up to 3).
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Authorization
** You MUST check these boxes in order to for your application to be accepted
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Would you agree to a pre-employment and/or post-employment drug screening by aphysician, clinic or other health care provider selected by the company?
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"I certify that the facts contained in this application are true and complete to the best of my knowledge and understandthat, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you anyand all information concerning my previous employment and any pertinent information they may have, personal or otherwise,and release the company from all liability for any damage that may result from utilization of such information. l also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing andsigned by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by theAmericans with Disabilities Act (ADA) and other relevant federal and state laws."
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