Professional Documents
Culture Documents
GENERAL INFORMATION
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Street
TELEPHONE NO.
City
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WORK
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HOME
CELL
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FULL TIME
State
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Zip
PART TIME
_____
HOURS
_______________
______________
NO
ARE THERE ANY HOURS OR DAYS WHICH YOU CANNOT WORK? YES
NO
IF YES, WHAT ARE DAYS AND TIMES YOU CANNOT WORK: _____________________________________________________________
ANY RELATIVES WHO ARE DIRECTORS OR EMPLOYEES EMPLOYED BY US?
HAVE YOU PREVIOUSLY APPLIED OR BEEN EMPLOYED WITH US?
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WHY ARE YOU SEEKING A CHANGE IN EMPLOYMENT?
HAVE YOU EVER BEEN TERMINATED FROM EMPLOYMENT REGARDING A THEFT? YES
IF YES, PLEASE EXPLAIN:
NO
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HAVE YOU EVER BEEN CONVICTED OF A CRIME OTHER THAN A MISDEMEANOR? YES
IF YES, PLEASE EXPLAIN:
NO
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PLEASE PROVIDE ANY ADDITIONAL INFORMATION SUCH AS SPECIAL SKILLS, TRAINING, MANAGEMENT EXPERIENCE, EQUIPMENT
OPERATION, OR OTHER QUALIFICATIONS YOU FEEL WOULD BE HELPFUL TO US IN CONSIDERING YOUR APPLICATION.
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EMPLOYMENT RECORD
DATES
SALARY
SUPERVISOR
REASON
FOR
LEAVING
OF EMPLOYER
REFERENCES
LIST FOUR BUSINESS REFERENCES WHO HAVE KNOWLEDGE OF YOUR ABILITY.
NAME
YEARS
KNOWN
NO
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EDUCATION
MAJOR OR
COURSES
DEGREE
HIGH
SCHOOL
COLLEGE
OR
UNIVERSITY
OTHER
SCHOOLS
CAREER OBJECTIVES
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AGREEMENT
We are an equal opportunity employer and do not discriminate in recruiting, hiring, training,
promoting or other employment practices, on the basis of race, color, religion, sex, sexual orientation,
marital status, age, national origin, or veteran or handicap status, or any other legally protected
status. No question in this application is intended to obtain information to be used for such
discrimination.
I understand that I must be a U.S. Citizen or a properly authorized alien to qualify for
employment.
I understand that employment is for no definite period of time and it may be terminated at any
time by either the Company or me.
I agree to abide by all policies and rules and that all Company information is strictly confidential.
I understand that, prior to being offered employment, I may be requested to take an employment
examination.
I hereby authorize The Barleycorn to investigate all information in this application and to secure
additional information in the course of that investigation. I authorize all reference, and any other
persons contacted, to answer all questions asked related to my ability, reputation, character, and
previous employment record.
I certify that all statements by me on this application are true and complete and, if not, are causes
for disqualification or termination. This application is active for 60 days unless renewed by
applicant.
________________________________
Applicant Signature
_____________________________
Date
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