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Employment Application Form Application Date Interview Date .
General Information
Last Name First Name Initial Social Security No.
Address Home Telephone
City, State, Zip Message Telephone
Position Applied For Salary Desired
Date Available Hours Available__________________________________________
■■ FULLTIME ■■ PARTIME ■■ TEMPORARY ■■ PERMANENT
If hired, will you be able to work overtime?
■■ YES ■■ NO
Are you at least 18 years of age? If under 18, do you have a work permit?
■■ YES ■■ NO ■■ YES ■■ NO
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by
court? A yes response does not automatically disqualify your application. If yes, please explain. ■■ YES ■■ NO
Education Information
School Address Major Studies Degree, Diploma, License
or Certificate (list type and date)
High School
Vocation/Business/Other
College/university
College/university
Graduate
Other Special Knowledge, Skills otQualifications (list any construction or manufacturing equipment, office skills, technical equipment or training)
Military Service (list dates, ranks and training)
For Clerical Applicants Only:
Do you type?
■■ NO ■■ YES: __________WORDS PER MINUTE
ComputerSkills (hardware/software)
YEH Form: Employment Application 1002
Are you able to peform the essential job functions of
the position you are applying with or without reasonable
accommodations? ■■ YES ■■ NO