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August 2008
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Apply For Employment
 
General Information
 
First Name:
 Address:
Middle Name:
 City:
Last Name:
State:
Email:
 Postal Code:
Phone:
  
   
 
Availability
 
Position Applying For:
Are you legally able to be employed in the U.S.? yes | no
How did you hear about this employment?
Do you own a laptop? yes | no
Do you have transportation? yes | no
Total hours available per week:
Hours Available
Mon
Tues
Wed
Thur
Fri
Sat
Sun
From:
To:
 
School Most Recently Attended
 
Name:
 Phone:
Address:
City:
State:
 Postal Code:
   
Teacher or Counselor:
 Department:
Last Grade Completed:
 Grade Point Average:
Did you graduate?
yes | no		 Are you still enrolled?
yes | no
Sports or Activities:
  
   
Employment History
(If not applicable, list work performed on a volunteer basis or personal references.)
1. Company:
 City:
Address:
Postal Code:
State:
 Phone:
   
Job Title:
 Supervisor:
Date Worked From:
/ / mm/dd/yyyy		 Date Worked To:
/ / mm/dd/yyyy
Rate Of Pay:
$ per 		Reason For Leaving:
 
 
2. Company:
 City:
Address:
Postal Code:
State:
 Phone:
   
Job Title:
 Supervisor:
Date Worked From:
/ / mm/dd/yyyy		 Date Worked To:
/ / mm/dd/yyyy
Rate Of Pay:
$ per 		Reason For Leaving:
 
 
3. Company:
 City:
Address:
Postal Code:
State:
 Phone:
   
Job Title:
 Supervisor:
Date Worked From:
/ / mm/dd/yyyy		 Date Worked To:
/ / mm/dd/yyyy
Rate Of Pay:
$ per 		Reason For Leaving:
   
U.S. Military
 
Branch of Service:
 Date Entered:
/ / mm/dd/yyyy
Highest Rank Achieved:
 Date Of Discharge:
/ / mm/dd/yyyy
Do you have service-related skills and experience applicable to civilian employment?
yes | no
If yes, describe:
 
Other
During the past 5 years, have you ever been convicted of, pled guilty to or pled no contest to, a crime, excluding misdemeanors and traffic violations? yes | no
If yes, describe in full:

(*A conviction will not necessarily bar you from employment)
Applicants are not required to disclose sealed or expunged conviction records or the existence of such records.
Are you or have you ever been a sex offender registered with any federal, state or local government agency, including any listing on a public web site? yes | no
 
PLEASE READ CAREFULLY THE SECTION BELOW BEFORE SUBMITTING.
  1. I certify that I have read this application and the information on it is complete and correct. I understand that any omissions or misrepresentation of information is grounds for dismissal.
  2. I authorize the persons, employers, schools and organizations listed on this application to give you any information concerning my employment and other pertinent information they may have, personal and otherwise, and release all parties from all liability and damages that may result from furnishing this to you.
  3. At Yourareacode LLC employment is at will. This means an employee is free to terminate his/her employment at any time, without any reason, with or without cause, and Yourareacode LLC retains these same rights.
  4. Yourareacode LLC is an Equal Opportunity Employer. Various federal, state, and local laws prohibit discrimination on account of race, color, religion, sex, age, national origin, disability or veterans status. It is Yourareacode LLC’s policy to comply fully with these laws, as applicable, and information requested on this application will not be used for any purpose prohibited by law.
  5. I understand that as a part of the procedure for my employment application an investigative consumer report may be made concerning my character, general reputation, personal characteristics and mode of living. Upon written request, additional disclosure concerning the complete nature and scope of the investigation will be provided. If I am denied a job based either wholly or in part because of information contained in an investigative consumer report, I will be provided the name and address of the reporting agency that supplies the information.
 
By checking this box, I agree that all of the above information is accurate
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