Fillable Employment Application

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Employment Application

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The Employment Application form is 2 pages long and contains:

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File type: PDF

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COMPANY OR
EMPLOYER NAME:
POSITION APPLIED FOR:
APPLICANT TELEPHONE:
SOCIAL SECURITY NUMBER:
YOUR NAME:
Last First Middle
ADDRESS:
Yes No (If yes, verification will be required.)
Yes No
No
IF NECESSARY FOR THE JOB, ARE YOU OVER (Please mark one)
I WILL BE ABLE TO REPORT TO WORK ____ DAYS AFTER BEING NOTIFIED THAT I AM HIRED.
EDUCATION: Yrs. Completed
High School
College/University
Business/Technical
Other (May include grammar school)
MILITARY SERVICE:
Duty/Specialized Training:
REFERENCES: List two personal references who are not relatives or former supervisors.
Name
Occupation
Years known
Name
Occupation
Years known
EMPLOYMENT:
Employer Name and Address Position Title/Duties Skills Dates Employed
from to
Reason for leaving
Supervisor's Name: Telephone:
Employer Name and Address Position Title/Duties Skills Dates Employed
from to
Reason for leaving
Supervisor's Name: Telephone:
of the position with or without accommodations?
Provide a valid Alaska Drivers License?
IF NECESSARY FOR THE JOB I AM ABLE TO:
Work (which shifts)?
Work overtime?
Employment Application
Graduate or Degree
Address
Yes No
ARE YOU LEGALLY ELIGIBLE FOR EMPLOYMENT IN THE U.S.A.?
I AM SEEKING A PERMANENT POSITION:
Address
Are you able to perform the essential functions
Yes
Telephone
Telephone
Field of Study
14__ 15__ 16__ 18__ 19__ 21__
Developed at employer request by the Alaska Department of Labor and Workforce Development, Employment Security Division genapp (r03/00)
Select:
Select:
Select:
EMPLOYMENT CONTINUED…
Employer Name and Address Position Title/Duties Skills Dates Employed
from to
Reason for leaving
Supervisor's Name: Telephone:
Employer Name and Address Position Title/Duties Skills Dates Employed
from to
Reason for leaving
Supervisor's Name: Telephone:
Summarize other
employment related to this job:
Types of computers, other electronic or mechanical
equipment that you are qualified to operate or repair:
Typing speed: per minute.
Professional Licenses, Certifications or Registrations:
Additional skills including supervision skills, other languages, or information
regarding the career/occupation you wish to bring to the employer's attention:
In case of accident or illness please contact: Name:
Address:
Information to the applicant:
As part of our procedure for processing your employment application, your personal and employment
references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you
may be discharged from your job. You may make a written request for information derived from the checking of your references.
If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the US,
have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms.
I understand and agree to the information shown above:
Signature: Date:
Equal Employment Opportunity:
While many employers are required by federal law to have an Affirmative Action Program, all
employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and
reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.
Employer Section:
Daytime phone:
Relationship:
Developed at employer request by the Alaska Department of Labor and Workforce Development, Employment Security Division genapp (r08/02)
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Employment Application

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Completed 21 February 2022

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