Eligibility |
Are you over 18 years of age? |
Yes
No
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May we contact your present or previous employers? |
Yes
No
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If no, tell us why: |
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In order to permit a check of your work and education records, should we be made aware of any change of name or assumed name that you previously used? |
Yes
No |
If yes, verify names and dates: |
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Have you ever been discharged or involuntarily forced to resign from any employment? |
Yes
No
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If yes, explain: |
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Are you eligible for rehire from previous employers? |
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Except for vacations and holidays, how many work days were you absent during the past calendar year? |
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Except for vacations and holidays, how many work days were you absent during the previous year? |
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Comments on absences? |
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If you are applying for a position involving evening or weekend work, can you fulfill such scheduling requirements? |
Yes
No
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Are you willing to work overtime as requested? |
Yes
No
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If employment is offered, can you submit a birth certificate, social security card, and certificate of U.S. citizenship or verification of your legal right to work in the U.S. |
Yes
No
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- If employment is offered, can you produce personal identification such as US passport, driver’s license, or photo I.D. issued by the State?
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Yes
No
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Proof will be required upon hire. |
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Have you ever been convicted of a felony? |
Yes
No
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If yes, describe in full. A conviction is not an automatic bar to employment.
Facts and circumstances will be considered.
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