Tell us about you
Please complete as many fields as possible. Fields in red are required.
I agree to notify the company within 24 hours (for pending applicants) or at the beginning of my first shift after an incident if I should be convicted of a felony, or any crime involving dishonesty or breach of trust, or for arrest of a moving violation or upon conviction of a moving violation or such violation which could have been charged as such during my period of employment, if hired.
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EXTERNAL DISCLOSURE: I authorize any person, school, current employer (except as previously noted), past employer, and organizations named in this application form to provide the company with relevant information and opinion that may be useful to the company in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.
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DRIVING RECORD: I give permission for a complete check of my driving record including any state where I presently have or have had a driver’s license or permit.
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PHYSICAL EXAMINATION: I give permission for a complete employment physical examination, including a drug screening exam and x-rays. I consent to the release to the company of any and all medical information, as may be deemed necessary by the company in judging my capability to do the work in which I am applying.
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Have you ever been convicted of a crime, other than a civil traffic offense for which you could have been fined or sentenced to jail or prison even if the sentence was suspended or deferred
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If yes, please explain:
HONESTY & INTEGRITY: I understand that if the company terminates my employment for dishonesty, breach of trust, or any criminal acts the authorities may be notified and I may be criminally prosecuted. I also understand that, if hired, I may not hold other employment, nor engage in sales, investment or other activities that create a conflict of interest with my position
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Are you related to any current employee?
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If yes, please explain:
AT WILL EMPLOYMENT: I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of any wages or salary, be terminated at any time.
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Position Applying For Required
Will Accept: Part-Time, Full-Time, Seasonal Required
Date you can start work Required
Where did you hear about this position?
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Radio
Newspaper
Current Employee
Online
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Please specify
Are you legally entitled to work in the U.S.?
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Radio
Newspaper
Current Employee
Online
Required
Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation?
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Are you over the age of 18?
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What days of the week are you available for work? Ex Mon-Sun, Mon-Fri, or other specific days Required
Do you have a vailid drivers license?
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Required
Driver's license number Required
Driver's license issuing state Required
Driver's license Class
Do you have a High School Diploma?
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Do you have a GED?
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Required
Year of Graduation (High School or GED) Required
Name of School, City, State
Post High School Education (List most recent)
Major/Course of Study
Earned Degree
Graduated?
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No
Year of Graduation?
Occupational License, Certificate, or Registation?
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Number, Issued By, Expiration Date of Occupational License, Certificate, or Registration
Are you a U.S. Military Veteran?
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Describe volunteer work, community involvement, hobbies, or other qualifications or skills.
Business Reference Name, phone number, address, City, State, Zip Required
Business Reference Name, phone number, address, City, State, Zip
Work Experience (List current or most recent first) Employer Required
Phone Number
Start Date Required
End Date Required
Hours Per Week Required
Street Address, City, State Required
Job Title
Duties, Skills, Equipment and Software used:
Reason for Leaving?
May we contact this employer?
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Last Salary
Last Supervisor
Work Experience- Employer Required
Phone Number
Start Date Required
End Date Required
Hours per week Required
Street address, city, state,
Job Title
Duties, Skills, Equipment, software used
Reason for leaving?
May we contact this employer?
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Last Salary
Last Supervisor
I certify the information contained in this application is true, correct, and complete. I understand that if I become employed, false statements reported on this application may be considered sufficient cause for dismissal.
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