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Personal Information

We are an equal employment opportunity employer. Our company is committed to offering employment to qualified individuals without regard to the applicant's race, color, national origin, age, sex, religion, diability, marital status or any other status protected by applicable federal or state law.
Name in full (required)
Social Security Number(required)
Home Address(required)
City/State/Zip(required)
Telephone #(required)
Email(valid email required)
Desired wage (per hour)(required)
Date available for work(required)
For which position are you applying?(required)
Dates available to work(required)
What hours?(required)
Are there any hours you cannot work? If yes, list hours:(required)
Have you ever worked for the company before?
Yes No
If yes, give approximate dates when you were last employed and location(s) where you worked:(required)
List relatives working at this location(s)(required)
Do you possess leagal authorization to work in the United States?
Yes No
Are you at least 18 years old?
Yes No
If no, please identify your age and birth date(required)

Employment

Account for the last 3 years of employment, begining with your most recent job. All time must be accounted for. Complete all known information as to each former employer in the space below
Name, address & ph# of company(required)
Supervisor's name(required)
Dates Employed (From/To)(required)
Position Title(required)
Wages paid/Salary earned(required)
Reasons for leaving employment(required)
Brief description of duties(required)
Name, address & ph# of company
Supervisor's name
Dates Employed (From/To)
Position Title
Wages paid/Salary earned
Reasons for leaving employment
Brief description of duties
Name, address, & ph# of company
Supervisor's name
Dates Employed (From/To)
Position Title
Wages paid/Salary Earned
Reasons for leaving employment
Brief description of duties
Please identify any period of unemployment
Were you actively seeking full-time employment during these periods of unemployment?
Yes No

Employment References

Do not include family members or supervisors identified in Employment History section above.
Reference #1. Name, Address & Ph#(required)
Reference #2. Name, Address & Ph#(required)
Reference #3. Name, Address & Ph#(required)

Statement of Ability

Are you able to perform all of the essential functions of the position for which you have applied with or without accomodation?
Yes No
If no, please explain:

Prior Terminations

Have you ever been discharged or forced to resign your employment for misconduct or unsatisfactory work performance?
Yes No
If yes, give details, including the reason that you were told you were terminated:
Do you agree that the reason given for your termination was valid?
Yes No
If not, please explain why:
Have you been disciplined for absenteeism or violations of attendance policies during the past 3 years?
Yes No
If so, please explain why:

Miscellaneous

Have you ever been convicted of any crime (other than minor traffic violations) within the last 5 years?
Yes No
If your answer is "yes", explain the details of the crime for which you were conviceted.
Have you ever been sued in civil court for an intentional tort such as assault or battery?
Yes No
If yes, please describe the nature of the legal claim brought against you, when the claim was brought and how the claim was resolved:
Do you speak or read any other language other than English?
Yes No

Understandings

Please initial each of the following:
I understand that if hired, I will be placed on a 90-day probationary period. I further understand that in accordance with the Florida Statute Section 443.131(3)(a)(2), if I am terminated for unsatisfactory work performance within the 90-day probationary period, the Company's unemployment account shall not be charged for any unemployment benefits paid to me.(required)
I understand and agree that all policies and procedures of the Company may be modified, amended or deleted by the employer with or without notice to me or such amendment, modification or deletions; that the policies and procedures, whether oral or written, are to be advisory only, and are not to be interpreted as a contract of employment, and that my employment may be terminated at the will of either myself or the Company, with or without notice by either party. I also understand any other arrangements, agreements or understandings regarding the terms of employment are hereby canceled and superseded and that no amendment or exception to this statement is valid unless in writing and signed by a corporate officer or the company.(required)
I agree that, in its discretion, the Company may search me and any or all of my belongings or property that I bring onto the Company's property. (required)
I certify that all the information given on this employment application is true and correct. I understand that the employer will make a thorough investigation of my work and personal history. I authorize the giving and receiving of any such information requested by it. I understand that falsification of any information so given or other derogatory information discovered as a result of this investigation will subject me to immediate dismissal. I agree to a post-offer physical examination, if requested. If I am hired, I will conform to the rules and regulations of the Company.(required)
I understand that the Company will not tolerate sexual and other forms of unlawful harassment. I understand that I have the affirmative obligation to report it. I also understand that unlawful harassment is grounds for disciplinary action up to and including immediate discharge.(required)

Signature

Signature(required)
Date(required)

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