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It is
our policy to provide equal employment opportunity to all
qualified persons without regard to race, creed, color,
religious belief, sex, age, national origin, ancestry, physical
or mental handicap, or veteran status.
Name:
Last __________ First __________ Middle _________
Street
Address ______________________________________________________
City
______________________ State ____________ Zip _________________
Telephone
( ) ________________ Social Security # ____________________
Position
applied for ___________________________________________________
When
can you start _____________________ Desired Wage $ ______________
Are
you a U.S. citizen or otherwise authorized to work in the
U.S. on an unrestricted basis?
[ ]
Yes [ ] No
Are
you looking for full time employment? [ ] Yes [ ] No
If
no, what hours are you available? _______________
Have
you ever been convicted of a felony? [ ] Yes [ ] No
If
yes, please fully describe the circumstances:
_____________________________________________________
_____________________________________________________
Education:
School Name and Location / Year / Major / Degree
High
School _____________________________________________________
College
_____________________________________________________
College
_____________________________________________________
Other
_____________________________________________________
_____________________________________________________
In addition
to your work history, are there are other skills, qualifications,
or experience we should consider:
_____________________________________________________
Employment
History: (Start with most recent employer.)
Company
name _______________________
Address
__________________________________ Telephone _________________
Date
Started _______ Starting Wage _______ Starting Position
___________
Date
Ended ________ Ending Wage _______ Ending Position ___________
Name
of Supervisor ________________ May we contact? [ ] Yes [
] No
Responsibilities
_____________________________________________________
Reason
for leaving _____________________________________________________
Company
name _______________________
Address
__________________________________ Telephone _________________
Date
Started _______ Starting Wage _______ Starting Position
___________
Date
Ended ________ Ending Wage _______ Ending Position ___________
Name
of Supervisor ________________ May we contact? [ ] Yes [
] No
Responsibilities
________________________________________________________
Reason
for leaving ______________________________________________________
Company
name _______________________
Address
__________________________________ Telephone _________________
Date
Started _______ Starting Wage _______ Starting Position
___________
Date
Ended ________ Ending Wage _______ Ending Position ___________
Name
of Supervisor ________________ May we contact? [ ] Yes [
] No
Responsibilities
_____________________________________________________
Reason
for leaving _____________________________________________________
Attach
additional information if necessary.
I certify
that the facts set forth in this application for employment
are true and complete to the best of my knowledge. I understand
that if I am employed, false statements on this application
shall be considered sufficient cause for dismissal. This
company is hereby authorized to make any investigations
of my prior educational and employment history. I understand
that employment at this company is "at will,"
which means that either I or this company can terminate
the employment relationship at any time, with or without
prior notice, and for any reason not prohibited by statute.
All employment will continue on that basis. I understand
that no supervisor, manager, or executive of this company,
other than the president has the authority to alter the
foregoing.
Signature
_________________________ Date ____________________
Please
Fax or Mail the completed application to:
Thali
4 Orange Street
New Haven, CT
Fax:
203.777.1195
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