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For Services
24 hours a day:
(334) 742-2877
or (800) 815-0630
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Employment Application
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FOR
OFFICE USE ONLY
Date
Letter
Reference
Check by
Interview
for
App
#
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EDUCATION
High
School Diploma or GED? [ ]Yes [ ]No (Verification will be
required)
If
no, circle highest grade completed 1 2 3 4 5 6 7 8 9 10 11 12
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Name
and location of business, correspondence, or
vocational
school attended
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FROM
Mo.
Yr.
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TO
Mo.
Yr.
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Did
you
Graduate?
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Area
of
Study
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Degree
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Name
and location of Colleges and Universities attended
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FROM
Mo.
Yr.
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TO
Mo.
Yr.
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Did
you
Graduate?
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G.P.A.
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Maximum
obtainable
G.P.A.
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Field(s)
of Study
Major(s)
Minors(s)
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Degree
and
Date
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Graduate/Professional/Medical
School
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Residency/Internship/Fellowship
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List
professional certificates or licenses and state where issued
Is
your license current and in good standing? Yes No
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Educational
subjects and/or training related to the duties of the position for
which you are applying.
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Sem.
Hrs.
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Qtr.
Hrs.
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Office/business
machines operated
Software
packages operated
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Professional
Memberships
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Word
processing preference
Typing
Speed/WPM (net)
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Employment
applications are active for six months.
FORM 14-42 (07/01)
Have
you ever been disciplined or counseled for harassment, attendance,
or failure to follow policies? [ ] Yes [ ] No
Have
you ever been involuntarily terminated, or forced to resign from a
position (do not include layoffs)? [ ] Yes [ ] No
Have
you ever been convicted of a moving vehicle violation (including
speeding tickets & accidents) or
had
your driver's license suspended or revoked within the past 5
years? [ ] Yes [ ] No
Have
you ever been convicted of a crime? [ ] Yes [ ] No
Do
you have any pending legal charges? [ ] Yes [ ] No
If you answered "Yes" to any of the above
questions, attach an explanation on a separate sheet.
Can
you, upon employment, submit verification of your legal right to
work in the U.S.? [ ] Yes [ ] No
Are
you 18 years of age or older? [ ] Yes [ ] No
If no, do you have a work permit? [ ] Yes [ ] No
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WORK
HISTORY
Beginning with your PRESENT or most recent employment, list
in REVERSE ORDER periods of employment. Each time you changed jobs or
your title changed should be listed as a separate period. Describe in
detail your specific duties as they relate to the duties of the position
for which you are applying. Attach additional sheets if necessary.
1. Current or Last Employer
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Your Official Job Title
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Address
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Type of Business
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City State
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Telephone
( )
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From
Mo.
Yr.
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To
Mo. Yr.
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If
part-time,
number
of hours
per week
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Beginning
Salary
$ per
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Ending
Salary
$ per
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May
we contact
employer?
[ ] Yes [ ] No
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Name of Supervisor
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Reason for Leaving
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Describe your Duties
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2. Current or Last Employer
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Your Official Job Title
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Address
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Type of Business
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City State
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Telephone
( )
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From
Mo.
Yr.
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To
Mo. Yr.
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If
part-time,
number
of hours
per week
|
Beginning
Salary
$ per
|
Ending
Salary
$ per
|
May
we contact
employer?
[ ] Yes [ ] No
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Name of Supervisor
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Reason for Leaving
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Describe your Duties
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3. Current or Last Employer
|
Your Official Job Title
|
Address
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Type of Business
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City State
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Telephone
( )
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From
Mo.
Yr.
|
To
Mo. Yr.
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If
part-time,
number
of hours
per week
|
Beginning
Salary
$ per
|
Ending
Salary
$ per
|
May
we contact
employer?
[ ] Yes [ ] No
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Name of Supervisor
|
Reason for Leaving
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Describe your Duties
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4. Current or Last Employer
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Your Official Job Title
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Address
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Type of Business
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