Position applied for
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Lead Press Operator
Second Press Operator
Third Press Operator (Apprentice)
Typesetting, Layout and Graphic Design
Courier
Customer Service Supervisor
Customer Service Representative
Manager/Assistant Manager
Office Manager
Referral source
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If other:
Your Name
First
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Last
Address
Addr1
Addr2
City
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WI
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Zip
Telephone Number
Email
If under 18, can you
furnish a work permit?
N/A
Yes
No
Have you filed an application here before?
Yes
No
If yes, give date
Have you been employed here before?
Yes
No
If yes, give date
Are you employed now?
Yes
No
May we contact your present employer?
Yes
No
Are you prevented from lawfully becoming
employed in this county because of Visa or Immigration Status?
Yes
No
(Proof of citizenship
or immigration status will be required upon employment.)
On what date would you be available for
work?
Are you available to work?
Full Time
Part Time
Shift Work
Temporary
Are you on a lay-off and subject to recall?
Yes
No
Can you travel if a job requires it?
Yes
No
Have you been convicted of a felony within
the last 7 years?
Yes
No
(Conviction will not necessarily disqualify applicant
from employment)
If yes, please explain
Veteran of the US Military service?
Yes
No
If yes, give branch
List professional, trade, business or civic
activities and offices held. (You may exclude
membership-s which reveal sex, race, religion, national origin, age,
ancestry, or handicap or other protected status.)
Give name, address and telephone number of
three references who are not related to you and are not previous
employers.
* Reference 1
* Reference 2
* Reference 3
Employment Experience
Start with your present or last job. Include
military service assignments and volunteer activities. You may
exclude organization names which indicate race, color, religion, gender,
national origin, handicap or other protected
status.
Special Skills and Qualifications Summarize special skills and qualifications acquired
from
Special Employment
Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals With Physical Or Mental Handicaps
Government contractors are subject to 38 USFC
2012 of the Era Veterans Readjustment Act of 1974 which requires that
they take affirmative action to employ and advance in employment qualified
disabled veterans of the Vietnam Era, Section 503 of the Rehabilitation
Act of 1973, as amended, which requires government contractors to
take affirmative action to employ and advance in employment qualified
handicapped individuals.
If you are a disabled veteran, or have a physical or mental handicap
you are invited to volunteer this information which will be treated
confidential. Failure to provide this information will not
jeopardize or adversely affect your consideration for employment.
I Wish to be identified
Not Applicable
Handicapped Individual
Disabled Veteran
Vietnam Era Veteran
Applicant’s
Statement
I certify that answers given herein are true
and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application
for employment as may be necessary in arriving at an employment
decision.
This application for employment shall be considered active for
a period of time not to exceed 45 days. Any applicant wishing
to be considered for employment beyond this time period should inquire
as to whether or not applications are being accepted at that time.
The applicants understands that neither this document nor any other
offer of employment from the employer constitute an employment contract
unless a specific document to that effect is executed by the employer
and employee in writing.
In the event of employment, I understand that false or misleading
information given in my application or interview(s) may result in
discharge. I understand, also, that I am required to abide
by all rules and regulations of the employer.
I agree with the above
Yes
No
11-20-2008
Please click the submit button only once.
Allegra Print & Imaging - Tucson, AZ 