Employment Application
Employment Application

(Valid for only 90 days)

An Equal Opportunity Employer

Please answer all questions. Resumes are not accepted in lieu of completion of this application. Note: This application was designed to use with several types of job positions. Some questions may not be completely applicable to the job position you are seeking; however, we ask that you answer all questions.

* = Required

First Name *
Please type your full name.
Middle Name *
Last Name *
Please type your full name.
Date *
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Present Address *
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City and State *
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Zip Code *
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Home Telephone *
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Cell Phone
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Email *
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Position Applying For
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Only U.S. Citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity?
Citizen Proof *
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Have you ever been convicted of a crime? *
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If Yes, give dates and explain. A conviction will not necessarily disqualify you from employment.
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Do you have a current Florida Class D Security Officer License? *
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Class D License # and expiration
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EDUCATIONAL DATA

Print Name, Number and Street, City, State and Zip Code for each School
High School
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Years Completed
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Degree
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Major
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College
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Years Completed
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Degree
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Major
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Graduate School
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Years Completed
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Degree
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Major
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Trade, Bus, Night etc.
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Years Completed
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Degree
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Major
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Other
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Years Completed
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Degree
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Major
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List any other job-related skills or qualifications that support your application.
Other Skills
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Honors Received:
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In order to permit a check of your work and educational records, should we be made aware of any change of name or assumed name that you previously used?
Changed Name? *
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If Yes, identify names and relevant dates.
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Have you had prior educational experience which relates to the job for which you are applying?
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If Yes, describe:
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Are you a veteran of the U.S. Military Service?
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If Yes, what branch of Service?
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If Yes, beginning date and ending date of active duty:
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Date of Discharge from Military Service:
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EMPLOYMENT EXPERIENCE:

ALL CURRENT and FORMER JOBS (List most recent job first.) Account for all time periods including unemployment, self-employment and military service.
Employer
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Dates Employed
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Work Performed
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Address
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Job Title
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Hourly Rate / Salary (Starting / Final)
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Immediate Supervisor
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Telephone
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Reason for Leaving
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Employer
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Dates Employed
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Work Performed
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Address
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Job Title
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Hourly Rate / Salary (Starting / Final)
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Immediate Supervisor
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Telephone
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Reason for Leaving
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Employer
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Dates Employed
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Work Performed
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Address
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Job Title
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Hourly Rate / Salary (Starting / Final)
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Immediate Supervisor
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Telephone
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Reason for Leaving
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Employer
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Dates Employed
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Work Performed
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Address
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Job Title
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Hourly Rate / Salary (Starting / Final)
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Immediate Supervisor
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Telephone
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Reason for Leaving
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Employer
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Dates Employed
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Work Performed
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Address
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Job Title
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Hourly Rate / Salary (Starting / Final)
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Immediate Supervisor
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Telephone
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Reason for Leaving
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Employer
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Dates Employed
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Work Performed
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Address
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Job Title
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Hourly Rate / Salary (Starting / Final)
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Immediate Supervisor
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Telephone
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Reason for Leaving
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Have you ever been dismissed or forced to resign from any employment? *
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If Yes, please explain
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In case of emergency, notify
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Telephone
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Relationship
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Address
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Do you have transportation to work? *
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Do you have a valid driver’s license? *
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Driver’s license number
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Driver's License State
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Driver's License Expires
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Have you had any traffic violations in the past three years? *
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If yes provide date(s) and violation(s)
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Are there any hours, shifts or days you will not work?
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If Yes, explain:
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Will you work overtime if asked?
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Do you have any friends or relatives who work here?
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Name & Relationship
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Name & Relationship
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Are you now employed? *
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Are you on a layoff?
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Are you subject to recall?
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May we contact your present Employer?
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May we contact your previous employers?
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Please identify any exceptions and reasons for not contacting prior employers:
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CHARACTER REFERENCES:

List three persons not related to you, whom you have known at least one year.
Name
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Telephone
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Occupation
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Address
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Name
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Telephone
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Occupation
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Address
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Name
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Telephone
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Occupation
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Address
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Have you filed an application here before?
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If Yes, give date
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Have you ever been employed here before?
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If Yes, give dates
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NOTICE TO APPLICANTS: This employer complies with the Americans with Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job-related functions. If you are given a conditional offer of employment, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination. If required, all entering employees in the same job category will be subject to the same medical questionnaire and/or examination and all information will be kept confidential and in separate files.

APPLICANT’S STATEMENT

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give the Employer permission to contact schools, previous employers, references, and others, and hereby release the employer from any liability as a result of such contact. I understand that misrepresentation, omissions of facts or incomplete information requested in this application may remove me from further consideration for employment. In addition, if employed, any misrepresentations or omissions of facts called for in this application will be cause for dismissal at any time without any previous notice. Applicants accepted for employment should clearly understand that while we make every effort to provide steady, continuous work, we have no employment contracts, and we cannot guarantee the permanence of any position. Job tenure can be affected by many factors including business/economic conditions, changes in laws or employee policies, conformity to our work rules, job performance, etc. And of course, an employee may elect to leave on their own accord to seek other opportunities. I understand that my employment with the Employer is for no specific term and may be terminated by me or the Employer with or without notice or cause at any time. I further understand that no oral promise, employer policy, custom, business practice or other procedure (including the Employer’s Personnel Handbook or any personnel manuals) constitutes an employment contract or modification of the at-will employment relationship between me and the Employer. The contents of any employee handbook or personnel manuals, as well as other Employer policies and practices, are subject to change or modification by the Employer, solely at its discretion, without notice. I also understand that no supervisor or other official of the Employer (except its Chief Executive Officer, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing. We conduct our business with the highest possible degree of safety and efficiency. Because of this, the Employer may require applicants for employment to undergo blood and/or urinalysis screening for drug or alcohol use as part of our preplacement physical examination. In addition, all employees of the Employer are subject to blood tests or urinalysis screening for drug or alcohol use. This application will remain for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90) days should reapply. I agree in advance if there is a workmens’ compensation or health claim, I the undersigned agree to an illegal substance and alcohol testing and understand that if I test positive my benefits, if any, will be severely cut or none at all.
Virtual Signature *
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Date *
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This employer is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, handicap or marital status. We assure you that your opportunity for employment with this Employer depends solely upon your qualifications.

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