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Application for Employment
DOORS IN MOTION
(800) 960-7617
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.
Position Applied For
Date of Application
How Did You Learn About Us?
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Friend
Inquiry
Employment Agency
Relative
Other
Last Name
First Name
Middle Name
Full Address
Telephone Number
Social Security Number (voluntary)
Best Time to Contact you At Home is:
If you are under 18 years of age, can you provide required proof of your eligibility to work?
Yes
No
Have you ever filed an application with us before?
Yes
No
If Yes, Give Date:
Have you ever been employed with us before?
Yes
No
If Yes, give date:
Do any of your friends or relatives work here?
Yes
No
If Yes, state name, relationship and location:
Are you currently employed?
Yes
No
May we contact your present employer? .
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
(Proof of citizenship or immigration status will be required upon employment.)
Yes
No
Date available for work:
What is your desired salary range?
Are you available to work:
Full Time
Part Time
Temporary
If Full Time (Please indicate 1/2/3 shift)
If Part Time (Please indicate Mornings/Afternoon/Evenings)
If Temporary (Please indicate dates available)
Are you currently on "lay-off" status and subject to recall?
Yes
No
Can you travel if a job requires it?
Yes
No
EDUCATION
Undergraduate College
Graduate/Professional
Others(Specify)
ADDITIONAL INFORMATION
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.
Yes
No
EMPLOYMENT EXPERIENCE
Employer Name
Employer Address
Employer Telephone
Dates Employed (From-To)
.
Starting/Present Job Title
Supervisor
Hourly Rate/Salary (Starting-Final))
.
Work Performed
Reason for Leaving:
May we Contact?
Yes
No
Employer Name
Employer Address
Employer Telephone
Dates Employed (From-To)
.
Starting/Present Job Title
Supervisor
Hourly Rate/Salary (Starting-Final)
.
Work Performed
Reason for Leaving:
May we Contact?
Yes
No
REFERENCES:
Name
Phone
Best Time to Call
Occupation
Name
Phone
Best Time to Call
Occupation
Name
Phone
Best Time to Call
Occupation
APPLICANT's STATEMENT
I certify that answers given herein are true and complete.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Employer.
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