Employment Application

EMPLOYEE INFORMATION

Are you able to perform the essential functions of the position with or without accommodations?



If necessary for the job are you older than:







I am legally eligible for employment in the U.S.?



Am I seeking a permanent position:



Number of days to report to work after being notified I am hired.:

If necessary for the job, I am able to work overtime?



If necessary for the job, I am able to provide a valid Florida Driver's License?



If so, fill out the following:

Work the following shifts: (check all that apply)

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
EMPLOYMENT HISTORY

List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.

Employees Name and address:
Position title/duties, skills:
Start Date
End Date
Employees Name and address:
Position title/duties, skills:
Start Date
End Date
Employees Name and address:
Position title/duties, skills:
Start Date
End Date
EDUCATION
High school
Institution Name
Years Completed
Field Of Study
Degree or Graduate
College/University
Institution Name
Years Completed
Field Of Study
Degree or Graduate
Business/technical
Institution Name
Years Completed
Field Of Study
Degree or Graduate
Additional
Institution Name
Years Completed
Field Of Study
Degree or Graduate
MILITARY

Are you a veteran?



Duty/specialized training:
SKILLS & QUALIFICATIONS

Other qualifications such as special skills, abilities or honors that should be considered:

Types of equipment you are qualified to operate or repair:

Professional licenses, certification or registrations:

Additional skill, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employer's attention:

REFERENCES

List two personal references who are not relatives or former supervisors.

Name
Address
Telelphone
Occupation
Years Known
Name
Address
Telelphone
Occupation
Years Known
CONTACT

In case of accident or illness, Please contact:

INFORMATION TO THE APPLICANT

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.

If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above.

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.

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