Careers

11.  Job Skills:  Use the following space to provide any additional information that you think would be helpful in our evaluation of your job application.  This can include specialized training, seminars, workshops, accreditations, special achievements or valuable skills:

12.  Licenses Held: (including drivers) or certifications to practice a trade or profession.

Type

License Number

Granted by (licensing board)

13.  References:

List the full name, address, phone number and relationships of up to three persons that you’d like to use as a reference:

Full Name

Address

Phone Number

Relationship

14.  Miscellaneous Information:

14a.  Which shifts are you willing to  accept:   Day   Evening   Night   Rotating   Weekends  Specify shift hours

14b.  Which job status are you willing to accept:   Full-time   Part-time (specify)

14c.  Are you willing to travel:   No   Yes

14d.  Please indicate your geographic preferences:

15.  Compliance with the Immigration Reform and Control Act requires that you are you legally eligible for employment in the United States?

 Yes    No. 

Please note that under the Immigration Reform and Control Act of 1986, you may be required to fill out a certification verifying that you are eligible to be employed and verifying your identity.  You may also be required to provide documentation should you be employed.

16. Veteran Status:  Are you a veteran who received an honorable discharge and has:

1. Provided  more than 180 consecutive days of full time active duty in the armed forces of the United States or reserve components, including the National Guard?, or

2.  Have a military service disability rating fixed by the United States Veterans Affairs?

         Yes  No.  If yes, did you serve during the Vietnam Conflict (2/28/61-3/7/75)?  Yes  No

17. Prior Convictions:

17a.  Have you ever been convicted of any violation of law, including moving traffic violations:   Yes  No

   If yes, then please provide the following:

Describe the Offense :      

Statute / Ordinance (if known):

      Date of Charge:      ;  Date of Conviction     

County, City,  and State of Conviction:

18.  Work Start Date:  When will you be available to start work?  If you are available as soon as you’ve given two week’s notice, then no dates are necessary.

Month

Day

Year

19.  Job Application Certification:

I hereby certify that all entries on this job application and any attachments are true and complete.  I also agree and understand that any falsification of this information may result in my forfeiture of employment.

I understand that all information on this job application is subject to verification and I consent to criminal history and background checks.  I also agree that you may contact references and educational institutions listed on this application

Dated

Job Applicant Signature