GRACE ON MAIN - Employment Application
Employment Application
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FULL NAME *
ADDRESS *
PHONE NUMBER *
EMAIL *
APPLYING FOR *
DATE AVAILABLE TO START EMPLOYMENT *
MM
/
DD
/
YYYY
AVAILABILITY (DAYS) *
Required
AVAILABLE TIMES LISTED BY AVAILABILITY IDENTIFIED ABOVE *
IF UNDER THE AGE OF 16, YOU MUST HAVE A WORK PERMIT. DO YOU HAVE A WORK PERMIT? *
ARE YOU A CITIZEN OF THE UNITED STATES? *
IF NO, ARE YOU AUTHORIZED TO WORK IN THE US? *
HAVE YOU EVER BEEN CONVICTED OF A FELONY? *
IF YES, PLEASE EXPLAIN
EDUCATION - HIGH SCHOOL (DATE FROM/TO) *
EDUCATION - COLLEGE (DATE FROM/TO) *
LIST TWO PROFESSIONAL REFERENCES (FULL NAME, RELATIONSHIP, COMPANY, PHONE NUMBER) *
CURRENT / PREVIOUS EMPLOYMENT - COMPANY NAME *
CURRENT / PREVIOUS EMPLOYMENT - ADDRESS *
CURRENT / PREVIOUS EMPLOYMENT - PHONE NUMBER *
CURRENT / PREVIOUS EMPLOYMENT - JOB TITLE *
CURRENT / PREVIOUS EMPLOYMENT - STARTING SALARY *
CURRENT / PREVIOUS EMPLOYMENT - ENDING SALARY *
CURRENT / PREVIOUS EMPLOYMENT - EMPLOYMENT DATES (FROM/TO) *
CURRENT / PREVIOUS EMPLOYMENT - RESPONSIBILITIES *
CURRENT / PREVIOUS EMPLOYMENT - REASON FOR LEAVING *
MAY WE CONTACT YOUR CURRENT / PREVIOUS EMPLOYER FOR A REFERENCE? *
LIST ANY ADDITIONAL EMPLOYMENT EXPERIENCE RELEVANT TO THE POSITION
PLEASE EXPLAIN WHY YOU THINK YOU WOULD BE A GOOD FIT FOR THE POSITION *
DISCLAIMER AND SIGNATURE: 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 my result in my release. *
SIGNATURE (TYPE NAME) *
DATE SIGNED *
MM
/
DD
/
YYYY
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