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    Staff Application Jan 2007

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    bec
    This document is an application for employment. It requests basic personal information such as name, address, phone number, and email. It asks about availability, age, previous employment history including companies and dates worked. Educational history is also requested including schools attended and degrees obtained. Relevant certifications and memberships are listed. Work history is detailed with employer name, dates of employment, salary, duties and supervisor contact information. The applicant signs to authorize background checks and certify the truthfulness of the information provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC or read online from Scribd

    Staff Application Jan 2007

    Uploaded by

    bec
    27 views2 pages
    This document is an application for employment. It requests basic personal information such as name, address, phone number, and email. It asks about availability, age, previous employment history including companies and dates worked. Educational history is also requested including schools attended and degrees obtained. Relevant certifications and memberships are listed. Work history is detailed with employer name, dates of employment, salary, duties and supervisor contact information. The applicant signs to authorize background checks and certify the truthfulness of the information provided.

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    © Attribution Non-Commercial (BY-NC)

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    This document is an application for employment. It requests basic personal information such as name, address, phone number, and email. It asks about availability, age, previous employment history including companies and dates worked. Educational history is also requested including schools attended and degrees obtained. Relevant certifications and memberships are listed. Work history is detailed with employer name, dates of employment, salary, duties and supervisor contact information. The applicant signs to authorize background checks and certify the truthfulness of the information provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC or read online from Scribd
    Download as doc
    27 views2 pages

    Staff Application Jan 2007

    Uploaded by

    bec
    This document is an application for employment. It requests basic personal information such as name, address, phone number, and email. It asks about availability, age, previous employment history including companies and dates worked. Educational history is also requested including schools attended and degrees obtained. Relevant certifications and memberships are listed. Work history is detailed with employer name, dates of employment, salary, duties and supervisor contact information. The applicant signs to authorize background checks and certify the truthfulness of the information provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC or read online from Scribd
    Download as doc
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    APPLICATION FOR EMPLOYMENT

    EQUAL OPPORTUNITY EMPLOYER


    Date of Application Last Name First Name Middle Name

    Address (Street Number and Name) City State Zip Code

    Home Phone Mobile Phone Email Address

    Availability- When are Are you 18 or older? Have you ever been employed Position Applied for:
    you able to start? by ASNC before? If so, when?

    Salary Requirements Job Status You Would Accept Please Indicate Your Referral Source
    ‫ ٱ‬Full Time ‫ ٱ‬Part Time

    EDUCATION
    Name Dates Attended Grad? # of Major/Minor Type of Degree
    Hours Received
    High School From: Yes

    To: No
    College From: Yes

    To: No
    College From: Yes

    To: No
    Graduate From: Yes

    To: No
    Trade, From: Yes
    Business,
    Other To: No

    Relevant Workshops and Seminars Attended:

    Please List Membership in any Professional, Honorary, or Technical Societies:

    Do you have any of the following Red Cross or equivalent credentials? If yes, please state the expiration date.
    First Aid Certificate CPR Certificate Water Safety Instructor Advanced Lifesaving
    WORK HISTORY (include volunteer experience)
    Current or Last Employer: Address:

    Job Title: Supervisor’s Name: Telephone Number: No. Supervised by you:

    Date Employed (mo/yr) Starting Salary Ending Salary Reason for Leaving May We Contact
    $ per $ per Employer?
    Date Separated (mo/yr) List major duties in order of their importance in the job:

    Full Time Years Months

    Part Time Years Months

    If PT, number of hours


    worked per week:
    Previous Employer: Address:

    Job Title: Supervisor’s Name: Telephone Number: No. Supervised by you:

    Date Employed (mo/yr) Starting Salary Ending Salary Reason for Leaving May We Contact
    $ per $ per Employer?
    Date Separated (mo/yr) List major duties in order of their importance in the job:

    Full Time Years Months

    Part Time Years Months

    If PT, number of hours


    worked per week:
    Previous Employer: Address:

    Job Title: Supervisor’s Name: Telephone Number: No. Supervised by you:

    Date Employed (mo/yr) Starting Salary Ending Salary Reason for Leaving May We Contact
    $ per $ per Employer?
    Date Separated (mo/yr) List major duties in order of their importance in the job:

    Full Time Years Months

    Part Time Years Months

    If PT, number of hours


    worked per week:

    I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the
    event confirmation is needed in connection with my work, I authorize educational institutions, associations,
    registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I
    authorize investigation of all statements made in this application and understand that false information or
    documentation, or failure to disclose relevant information may be grounds for rejection of my application,
    disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon
    employment shall be mandatory if fraudulent disclosures are given to meet position qualifications (Authority: G.S.
    126-30, G.S. 14-122.1).

    __________________________________________________________ _____________________________
    Signature of Applicant Date

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