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LAST NAME:
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FIRST NAME
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PRESENT ADDRESS
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PHONE NO.
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DATE
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POSITION DESIRED
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SALARY DESIRED
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DATE YOU CAN
START
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EDUCATION HISTORY: PLEASE LIST NAME, LOCATION, YEARS ATTENDED, SUBJECTS OF STUDY AND
GRADUATION DATE OF HIGH SCHOOL AND COLLEGE.
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FORMER EMPLOYERS: PLEASE LIST NAME,ADDRESS, POSITION, SALARY, START/LEAVE DATES AND
REASON FOR LEAVING YOUR LAST FOUR EMPLOYERS (STARTING WITH THE LAST ONE FIRST)
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REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN
ATLEAST ONE YEAR (PLEASE LIST THEIR NAME,ADDRESS, PHONE NO. AND YEARS YOU HAVE KNOWN
THEM)
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COMMENTS:
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AUTHORIZATION
"I certify that the facts contained in this application are true and complete to the best of my knowledge
and understand that if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed
above may have, personal or otherwise, and release the company from all liability for any damage that
may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any
agreement for employment for any specified period of time, or to make any agreements contrary to the
foregoing unless it is in writing and signed by and authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner of
prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."
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I agree to the above terms
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I DO NOT agree to the above terms
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