AUBURN EMPLOYMENT AGENCY



AUBURN EMPLOYMENT AGENCY“AN EQUAL OPPORTUNITY EMPLOYER”Last Name FORMTEXT ?????First FORMTEXT ?????Middle FORMTEXT ?????Date FORMTEXT ?????Street Address FORMTEXT ?????Home Phone( FORMTEXT ????? ) FORMTEXT ?????- FORMTEXT ?????Have you ever worked for us before?If yes, dates and location: FORMTEXT ?????Yes FORMCHECKBOX No FORMCHECKBOX Social Security Number N/APosition Desired FORMTEXT ?????Pay Expected FORMTEXT ?????Would you work:Days and hours you are available: FORMTEXT ?????Full-time FORMTEXT ?????Part-time FORMTEXT ?????On-call FORMTEXT ?????How did you learn of this opening? FORMTEXT ?????Do you currently have any relative(s) employed with us: FORMTEXT ?????When are you available to begin work? FORMTEXT ?????Yes (relation: ___ FORMTEXT ?????_)No FORMTEXT ?????After reviewing a list of the essential functions of the job or jobs for which you wish to be considered, is there any reason you cannot perform these job duties? Yes FORMCHECKBOX No FORMCHECKBOX If yes, please explain why you are unable to do these tasks and anything we might do to make performance possible. FORMTEXT ?????Have you ever been convicted of a crime other than a minor traffic violation?(A record of conviction does not disqualify applicant from employment consideration.)If yes, please describe:Yes FORMCHECKBOX No FORMCHECKBOX FORMTEXT ?????Retail Experience: (Please check all that apply) FORMCHECKBOX Retail Sales FORMCHECKBOX Cashier FORMCHECKBOX Visual Merchandising FORMCHECKBOX Floor Stocking FORMCHECKBOX Gift Wrapping FORMCHECKBOX Produce FORMCHECKBOX Warehousing FORMCHECKBOX Restaurant FORMCHECKBOX Personal Computer FORMCHECKBOX Floral Experience FORMCHECKBOX Supervision FORMCHECKBOX Buying FORMCHECKBOX Customer Service FORMCHECKBOX Balance Tills FORMCHECKBOX InventoryOffice Experience: (Please check all that apply)Typing _ FORMTEXT ?????__ wpm FORMCHECKBOX Dictaphone FORMCHECKBOX Ten-Key (touch/sight) FORMCHECKBOX Cash Register FORMCHECKBOX Multi-line Phones FORMCHECKBOX Accounting FORMCHECKBOX CRT FORMCHECKBOX Inventory Control FORMCHECKBOX Graphics FORMCHECKBOX Access FORMCHECKBOX Word FORMCHECKBOX Excel FORMCHECKBOX PageMaker FORMCHECKBOX PowerPoint FORMCHECKBOX Other: FORMTEXT ?????EDUCATIONName and location of schoolDate of GraduationDegree(s) receivedHigh School FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Trade/Business FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????College FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Graduate School FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????EMPLOYMENT HISTORYName and Address: FORMTEXT ?????Dates of EmploymentSalaryStart FORMTEXT ?????Start FORMTEXT ?????Finish FORMTEXT ?????Finish FORMTEXT ?????Job Title: FORMTEXT ?????Department: FORMTEXT ?????Supervisor: FORMTEXT ?????Phone Number: FORMTEXT ?????Duties and Responsibilities: FORMTEXT ?????Reason for Leaving: FORMTEXT ?????Name and Address: FORMTEXT ?????Dates of EmploymentSalaryStart FORMTEXT ?????Start FORMTEXT ?????Finish FORMTEXT ?????Finish FORMTEXT ?????Job Title: FORMTEXT ?????Department: FORMTEXT ?????Supervisor: FORMTEXT ?????Phone Number: FORMTEXT ?????Duties and Responsibilities: FORMTEXT ?????Reason for Leaving: FORMTEXT ?????REFERENCESNameAddressOccupationPhone Number1. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????( FORMTEXT ????? ) FORMTEXT ?????- FORMTEXT ?????2. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????( FORMTEXT ????? ) FORMTEXT ?????- FORMTEXT ?????3. FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????( FORMTEXT ????? ) FORMTEXT ?????- FORMTEXT ?????READ BEFORE SIGNINGI certify that the information on this application is complete, true, and correct. I also authorize the company to check the references and statements on this application. I understand and agree that if I am employed; my employment can be terminated with or without cause or reason and with or without prior notice, at any time, at the option of either the company or myself.Date: FORMTEXT ?????Signature: ................
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