Longnecks Application for Employment

Name: Enter Name

Required

Email: Enter Email

Required

If yes to the above, explain: Explanation

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Cell Phone: Enter Phone Number

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Home Phone: Enter Phone Number

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Home Address: Enter Address

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City: Enter City

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State: Enter State

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Zip code: Enter Zip

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Best time of day to be reached: Enter Time

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Desired Position: Enter Desired Position

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Availability:

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Full-Time

Part-Time

Are you eligible to work in the United States?

Required

YES

NO

Have you ever been convicted of a felony or misdemeanor other than a traffic violation?

Required

YES

NO

Date Available: Enter Date Available

Required

Rate of Pay Desired: Enter Rate of Pay Desired

Required

Referred by: Enter Referral

Required

MONDAY: Enter Earliest and Latest You Can Work

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TUESDAY: Enter Earliest Latest You Can Work

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WEDNESDAY: Enter Earliest Latest You Can Work

Required

THURSDAY: Enter Earliest Latest You Can Work

Required

FRIDAY: Enter Earliest Latest You Can Work

Required

SATURDAY: Enter Earliest Latest You Can Work

Required

SUNDAY: Enter Earliest Latest You Can Work

Required

Location Desired:

Required

WILDER

HEBRON

RICHWOOD

ALL LOCATIONS

Place of Employment (most recent): Enter Name of Employer

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Location (most recent): Enter Location

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Job Title: Enter Job Title

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Reason for Leaving: Enter Reason for Leaving

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From: Enter Date Started Employment

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To: Enter Last Date of Employment

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Last Pay Rate: Enter Last Pay Rate

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Describe Work: Describe the type of work you did

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Place of Employment (2): Enter Name of Employer

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Location (2): Enter Location

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Job Title 2: Enter Job Title

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Reason for Leaving (2): Enter Reason for Leaving

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From (2): Enter Date Started Employment

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To (2): Enter Last Date of Employment

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Last Pay Rate (2): Enter Last Pay Rate

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Describe Work (2): Describe the type of work you did

Required

Place of Employment (3): Enter Name of Employer

Required

Location (3): Enter Location

Required

Job Title (3): Enter Job Title

Required

Reason for Leaving (3): Enter Reason for Leaving

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From (3): Enter Date Started Employment

Required

To (3): Enter Last Date of Employment

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Last Pay Rate (3): Enter Last Pay Rate

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Describe Work (3): Describe the type of work you did

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High School: Enter High School Name and Location

Required

Grade Completed: Enter Enter Grade Completed

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College/University: Enter College Name and Location

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Grade Completed: Enter Grade Completed or Years Attended

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Major: Enter Major

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Vocational/Other: Enter Vocational School Name or Other and Location

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Level of Completion: Enter Certification or Level of Completion

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Other Training, Knowledge, Skills or Qualifications: Enter Your Other Training, Knowledge, Skills or Qualifications

Required

Military Service:

Required

Yes

No

Branch: Enter Military Branch

Required

Discharge Date/Rank: Enter Discharge Date and Rank

Required

Full Name (1): Enter Full Name (1)

Required

Relationship to Applicant (1): Enter Relationship to Applicant (1)

Required

Phone Number (1): Enter Phone Number (1)

Required

Years Known (1): Enter Years Known (1)

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Occupation (1): Enter Occupation (1)

Required

Full Name (2): Enter Full Name (2)

Required

Relationship to Applicant (2): Enter Relationship to Applicant (2)

Required

Phone Number (2): Enter Phone Number (2)

Required

Occupation (2): Enter Occupation (2)

Required

Full Name (3): Enter Full Name (3)

Required

Relationship to Applicant (3): Enter Relationship to Applicant (3)

Required

Phone Number (3): Enter Phone Number (3)

Required

Years Known (3): Enter Years Known (3)

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Years Known (2): Enter Years Known (2)

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Occupation (3): Enter Occupation (3)

Required

Full Name (Emergency Contact): Enter Full Name (Emergency Contact)

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Relationship to Applicant (Emergency Contact): Enter Relationship to Applicant (Emergency Contact):

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Phone Number (Emergency Contact): Enter Phone Number (Emergency Contact)

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Address (Emergency Contact): Enter Address (Emergency Contact):

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I agree that if my application is considered for employment, I understand that additional personal information will be required during interview.

Required

All information provided is accurate and truthful. If at any time information is found to be misrepresented or false, I understand my application will be rejected and subsequent employment will be terminated.

Required