ONLINE APPLICATION 

Todayís Date
First Name
Middle Initial
Last Name
Email Address
Address
 
City
State
Zip Code
Home Phone w/area code
Message Phone w/area code
Social Security Number
Referred By:
Position(s) desired
Date available for work
Salary Desired
Employment desired full-time
  part-time
  temporary
  internship
Days/Hours available for work 
Day Hours:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
   
WORK EXPERIENCE:
Begin with present or most recent employer first.  Please fill out completely even if you provide a resume.  Please indicate employer(s) whom you do not want contacted at this time.
  
Employer
Street or P.O. Box
 
City
State
Zip
Phone w/area code
Position/Title
Supervisorís Name
Supervisorís Title
Part or Full-Time?
Dates Employed 

From 

Month /Year
To  Month /Year
Starting Salary
Final Salary
Specific job duties
Reason for leaving

Check here if you do NOT wish this employer to be contacted
 
Employer
Street or P.O. Box
 
City
State
Zip
Phone w/area code
Position/Title
Supervisorís Name
Supervisorís Title
Part or Full-Time?
Dates Employed 
From  Month /Year
To  Month /Year
Starting Salary
Final Salary
Specific job duties
Reason for leaving

Check here if you do NOT wish this employer to be contacted
 
Employer
Street or P.O. Box
 
City
State
Zip
Phone w/area code
Position/Title
Supervisorís Name
Supervisorís Title
Part or Full-Time?
Dates Employed 
From  Month /Year
To  Month /Year
Starting Salary
Final Salary
Specific job duties
Reason for leaving

Check here if you do NOT wish this employer to be contacted
 
Employer
Street or P.O. Box
 
City
State

Zip

Phone w/area code
Position/Title
Supervisorís Name
Supervisorís Title
Part or Full-Time?
Dates Employed 
From  Month /Year
To  Month /Year
Starting Salary
Final Salary
Specific job duties
Reason for leaving

Check here if you do NOT wish this employer to be contacted
 
EDUCATION: 
High School 
Name of School
Street, City, State, Zip
# years completed
did you graduate?
Major Subject
Jr. College, College or University
Name of School
Street, City, State, Zip
# years completed
did you graduate?
Major Subject
Graduate/Technical schools
Name of School
Street, City, State, Zip
# years completed
did you graduate?
Major Subject
Additional training, special achievements, certificates or honors relevant to position applied for:
Special skills
Which languages other than English do you speak fluently?

PERSONAL HISTORY
If you are hired, will you be able to provide documentation of your legal right to work in  the United States as required by law?
Have you ever been convicted of a felony?    
If yes, state details and dates:
Conviction of a crime is NOT a bar to employment  - all circumstances will be considered.
Have you ever served in the United States Armed Forces?
Which branch? 
 Dates: From      to (mm/yyyy)
Reserve status
Indicate any special training received
 
BUSINESS OR PERSONAL REFERENCES

Name

Street, City, State, Zip
Area code
Telephone number
    
Name
Street, City, State, Zip
Area code
Phone w/area code
    
Name
Street, City, State, Zip
Phone w/area code
   
RESUME Insert resume in plain text format here:

 

Please read the following and write your name below, ďsigningĒ this document according to the terms outlined below:

I declare my answers to the questions on this application are true and give this company the right to investigate all references and information given.  I understand that any misrepresentation, falsification or material omission of information on this application may result in my failure to receive an offer or, if I am hired, in my dismissal from employment.  In consideration of my employment, I agree to conform to the rules and standards of the company and agree that my employment and compensation can be eliminated at will or without cause and with or without notice at any time whether at my option or at the option of the company.  I understand that no employee or representative of the company other than the President of the company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.  I understand that employment is considered discretionary for a maximum period of 90 days from the date of employment.  I also understand that all offers of employment are conditioned on the provision of satisfactory proof of any applicantís identity and legal authority to work in the U.S.  I have been given an opportunity to ask questions regarding company rules.  I understand that if I am hired, my employment will be at-will which means that either the company or I may terminate my employment at any time, with or without cause.  No company representative has made promises or other statements to me which imply that I will be employed, if I am hired, under any terms different from those stated above

   
Todayís Date
Name
 

  *  

 
Newburyport, MA
 978-465-4100
 
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