Employment Inquiry

I understand that this is not an Employment Application. This inquiry will, however, be reviewed and my qualifications considered for possible job opening in the near future. If this company finds my qualifications and employment back ground match a current opening, I will be contacted to complete an application for employment. The information below is needed to complete this review.

Name :

Position Applied For :Text AreaDate :Social Security # :Phone # :Email :Valid Driver’s License :YesNoDriver’s License # :No. of Years Address :City :State :Zip :

Type of employment available for :

Hours Available :Full Time Part TimeDays Available :MonTuesWed ThursFri

Employment Experience :

Employer :Position :Text AreaDates Employed :Text AreaPay Rate :Text AreaReason for Leaving :Text AreaPhone Number : Text Area

Education :

High School Completed :Text AreaTrade School Completed :Text AreaOther Applicable Training or Experience :Text Area

To be completed on a voluntary basis. Not for interview purposes. To be filed separate from application. In an effort to comply with all requirements regarding government record keeping, reporting and other legal obligation which may apply, we invite you to complete this applicant data survey. Providing this information is strictly voluntary. Failure to provide it will not subject to any adverse pesonnel decision or action . Your cooperation is appreciated. Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision. This information will be used and kept confidential in accordance laws and regulation.

Gender :MaleFemale

Please check one of the following equal employment opportunity identification group(s) :

Ethnicity :WhiteBlackHispanic American Indian/Alaska NativeAsian/Pacific IslanderMulticulturalUpload Your Resume :

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All individuals considered for employment are evaluated without regard to race, color , religion , gender, national origin, age marital or veteran status , the presence of a non -job related disability or any other legally protected status. If you understand this and have completed the form please press the submit button below.

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