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Job Application Form
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Last Name:
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First Name:
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Middle Name:
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Maiden Name:
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Present Address:
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State:
Zip:
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How Long at this Address:
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Social Security Number:
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-
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Telephone:
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E-Mail:
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Fax (if available):
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If under 18,
please list age:
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Position Applied For:
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And Salary Desired:
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Days/Hours Available to work:
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Employment Desired:
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Date available for work:
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Education
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School:
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Location (City, State):
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# Years Completed:
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Major & Degree:
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High School:
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College:
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Bus./Trade School:
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Professional School:
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Have you ever been convicted of a crime?:
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If yes, please state offenses and dates:
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Authorization
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Are you authorized to work in the United States? :
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Military
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Have you ever been in the US Armed Forces? :
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Specialty
Date entered
Discharge Date
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Work Experience:
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Please list your work experience for the past five years beginning with your most
recent job held.
If you were self-employed, give firm name.
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Name of Employer:
Name of last supervisor:
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Employment Dates:
Pay or Salary:
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/
Start:
Final:
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Employers Address:
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State:
Zip:
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Employers Telephone:
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Your last job title:
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Reason for leaving (be specific):
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List the jobs you held, duties performed, skills used or learned, advancements or
promotions while you worked at this job:
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Name of Employer:
Name of last supervisor:
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Employment Dates:
Pay or Salary:
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/
Start:
Final:
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Employers Address:
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State:
Zip:
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Employers Telephone:
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Your last job title:
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Reason for leaving (be specific):
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List the jobs you held, duties performed, skills used or learned, advancements or
promotions while you worked at this job:
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Name of Employer:
Name of last supervisor:
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Employment Dates:
Pay or Salary:
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/
Start:
Final:
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Employers Address:
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State:
Zip:
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Employers Telephone:
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Your last job title:
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Reason for leaving (be specific):
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List the jobs you held, duties performed, skills used or learned, advancements or
promotions while you worked at this job:
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Name of Employer:
Name of last supervisor:
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Employment Dates:
Pay or Salary:
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/
Start:
Final:
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Employers Address:
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State:
Zip:
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Employers Telephone:
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Your last job title:
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Reason for leaving (be specific):
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List the jobs you held, duties performed, skills used or learned, advancements or
promotions while you worked at this job:
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May we contact your present employer:
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May we contact past employers? :
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Did you complete this application yourself:
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If No, who did and why:
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Do you have transportation to work:
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Office - Computer
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Typing:
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WPM
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Word Processing:
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WPM
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Other:
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Personal Computer:
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if yes,
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Skills:
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List programs used:
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References:
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Please list two references other than Relatives or Previous Employers:
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Name & Position:
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Company:
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Address:
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Telephone:
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An Application form sometimes makes it difficult for an individual to adequately
summarize a complete background. Use the text area below to include any additional
information necessary to describe your full qualifications for the specific position
for which you are applying.
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Please read carefully
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APPLICATION FORM WAIVER
In exchange for the consideration of my job application by KEGEL (hereinafter called
"the Company") I agree that:
Neither the acceptance of this application nor the subsequent entry into any type
of employment relationship, either in the position applied for or any other position,
and regardless of the contents of employee handbooks, personnel manuals, benefit
plans, policy statements, ant the like as they may exists from time to time, or
other Company practices, shall serve to create an actual or implied contract of
employment, or to confer any right to remain an employee of the Company, or otherwise
to change in any respect the employment-at-will relationship between it and the
undersigned, and that the relationship cannot be altered except by a written instrument
signed by the President/General Manager of the Company. Both the undersigned ant
the Company may end the employment relationship at any time, without specified notice
or reason. If employed, I understand that the company may unilaterally change or
revise their benefits, policies and procedures and such changes may include redaction
of benefits.
I authorize investigation of all statements contained in this application. I understand
that the misrepresentation or omission of facts called for is cause for dismissal
at any time without any previous notice. I hereby give the Company permission to
contact schools, previous employers (unless otherwise indicated), references and
others, and hereby release the Company from any liability as a result of such.
I also understand tar (1) the Company has a drug and alcohol policy that may provide
for pre-employment testing as well as testing after employment; (2) consent to and
compliance with such policy is condition of my employment; and (3) continued employment
may be based on the successful passing of testing under such policy. I further understand
that continued employment may be based on the successful passing of job-related
physical examinations.
I understand that, in connection with the routine processing of your employment
application, the Company may request from a consumer reporting agency an investigative
consumer report including information as to my credit reports, character, general
reputation, personal characteristics, and mode of living. Upon written request from
me the Company will provide me with additional information concerning the nature
and scope of any such report requested by it, as required by the Fair Credit Reporting
Act.
I further understand that my employment with the Company shall be probationary for
a period of ninety (90) days, and further that anytime during the probationary period
or thereafter, my employment relation with the company is terminable at will for
any reason by either party.
This Company is an equal employment opportunity employer. We adhere to a policy
of making employment decisions without regard to race, color, religion, sex, sexual
orientation, national origin, citizenship, age or disability. We assure you that
your opportunity for employment with this Company depends solely on your qualifications.
Thank you for completing this application form and for your interest in our business.
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