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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
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