EQUAL
EMPLOYMENT OPPORTUNITY POLICY
- Applicants are considered for all positions without regard to
race, color, religion, sex, national origin, age, marital or
veteran status, or the presence of a non-job related medical
condition or handicap. |
Name in full
(First, Last)
|
|
Phone No.: |
|
Would you
prefer to work: |
Full
time |
Part
time |
Temporary |
What
days, nights, times can you work? |
|
Do
you have reliable transportation? |
YES
NO |
Date of Birth |
|
Home Address |
|
City |
|
State |
|
Zip/Postal Code |
|
Are you over 18
years of age? |
YES
NO |
Are you eligible
to work in the United States? |
YES
NO |
Do you have any
physical condition that may limit your ability to perform the job
for which you have applied? |
YES
NO
If yes, please explain:
|
Does heat,
standing on your feet or lifting cause you any difficulties? |
YES
NO
If yes, please explain:
|
Date/s you can
start: |
|
Are you employed
now? |
YES
NO |
Salary
requirements: |
|
WORK HISTORY |
Date employed |
Employer |
Position
|
Supervisor
|
From |
Name |
To |
Address |
Starting
salary |
Ending
salary |
Reason
for leaving
|
Date employed |
Employer |
Position
|
Supervisor
|
From |
Name |
To |
Address |
Starting
salary |
Ending
salary |
Reason
for leaving
|
Date employed |
Employer |
Position
|
Supervisor
|
From |
Name |
To |
Address |
Starting
salary |
Ending
salary |
Reason
for leaving
|
REFERENCES:
Name three persons other than relatives or former employers |
name |
address |
occupation |
phone no. |
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Indicate
languages you speak: |
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