APPLICATION FOR EMPLOYMENT
This application is only available in large print and Braille. If the format of this application is inconvenient for you, please contact our Human Resources manager and he will return your call sometime between a month from now and the day after you accept another job.Name:
Last First MI
Date of Birth (Defect): Benefits Denial Number (SSN): - -
Address:
Number and Street Apt/P.O. Box Number
City State ZIP Code
Email address: Phone:
Preferred method of communication
(check one so that we know which one not to use):
Email Phone
Date available to start: Fair rate of pay for this position:$ /hr.
(Special) Education:
HIGH SCHOOL:
School Name:
Address:
City: State: ZIP Code:
Graduation Date (or highest grade completed):
COLLEGE/UNIVERSITY/TECHNICAL SCHOOL:
School Name:
Address:
City: State: ZIP Code:
Graduation Date (or number of credits completed):
GRADUATE SCHOOL:
School Name:
Address:
City: State: ZIP Code:
Graduation Date (or number of credits completed):
EMPLOYMENT HISTORY:
(Who are we kidding? We know this will be your first real shot at a job)
Can you perform the tasks outlined in your job description without reasonable accommodations?
Good, you will have to X
Do you have unreliable paratransit to work? Yes No
PERSONAL REFERENCES
(Because we know you do not have professional references):
Reference 1:
Name: Phone Number:
Relationship:
Reference 2:
Name: Phone Number:
Relationship:
Reference 3:
Name: Phone Number:
Relationship:
