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Employment Application Form
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Steps
1.
Step One
This section is complete
This section is incomplete
2.
Education
This section is complete
This section is incomplete
3.
Previous Employment
This section is complete
This section is incomplete
4.
References
This section is complete
This section is incomplete
5.
Disclaimer and Signature
This section is complete
This section is incomplete
Step One
Applicant Information
Date
Date
Date
First Name
*
Last Name
*
Phone Number
*
xxx-xxx-xxxx
E-Mail
*
Address1
*
Address2
City
State
Zip
Position Applied for:
Are you eligible to work in the United States?
YES
NO
Employment Desired
Full Time
Part Time
Have you ever been convicted of a felony?
Yes
No
Hours of Work Per Week Desired
Are you able to work weekends?
Yes
No
Are you able to work evenings?
Yes
No
Are you able to work weekdays?
Yes
No
Continue
Education
High School
Did you Graduate?
Yes
No
Degree
College
Did you Graduate?
Yes
No
Degree
Other
Did you Graduate?
Yes
No
Degree
Continue
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Previous Employment
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
Can we contact your employer for a reference?
Yes
No
Previous Employer #2
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Previous Employer #3
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for Leaving
May we contact your previous employer for a reference?
Yes
No
Continue
|
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References
Please list three professional references
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
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Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for rejection of my application and that if hired I may be released form employment. I understand that any offer of employment is contingent upon passing a background check. I understand that employment with the DRC is "at will" and nothing in the the interview or hiring process, this application, or company policies are intended to create an employment contract between myself and the DRC. Employment may be terminated by either party at any time for any reason with or without notice.
I have read and agree with the above disclaimer
Yes
No
Date
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