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Location to which you are applying
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Acworth
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Dalton (Cleveland Ave.)
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Position Applied For
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Name
*
Phone #
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Email
*
Are you legally eligible for employment in the U.S.A?
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Yes
No
Are you seeking a permanent position?
Yes
No
For which shifts are you available?
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Morning
Afternoon
Evening
Overnight
Any
If necessary for the job, are you over the age of
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14
16
18
21
If hired, when are you available to start work?
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EDUCATION
High School Attended
College/University Attended
Business/Technical School Attended
Have you served in the United States Military sevice?
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Yes
No
REFERENCE #1
Name
*
Phone #
*
Occupation
Years known
*
REFERENCE #2
Name
Phone #
Occupation
Years known
Employment: List last employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary (following this section).
EMPLOYER #1
Employer Name and Address
Postion Title, Duties, and Skills
Supervisors Name
Supervisor Phone #
Dates Empolyed
From
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To
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January
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December
2008
2009
2010
2011
2012
2013
2014
EMPLOYER #2
Employer Name and Address
Postion Title, Duties, and Skills
Supervisor's Name
Supervisor Phone #
Dates Empolyed
From
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January
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To
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January
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April
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September
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November
December
2008
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2012
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2014
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Summarize other employment related to this job
Types of computers, other electronic or mechanical equipment that you are qualified to operate or repair
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Professional Licenses, Certifications or Registrations
Additional skills including supervision skills, other languages, or information regarding the career/occupation you wish to bring to the employer's attention
Information to the applicant: As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.
If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the US, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms.
I understand and agree to the information shown above (type your full name to digitally sign this form)
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Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask you your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.
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