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Employment Application - Dixie Southern

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PERSONAL INFORMATION

Last Name: First: Middle:
Address:
City: State: Zip Code:
Home Phone: Cell Phone:  
Email:
Have you ever been involuntarily terminated or requested to resign?
If Yes, please explain:
If hired, can you provide verification of your legal right to work in the United States?
Are you at least 18 years of age?
If required for the position, do you have a valid driver's license?
Have you ever worked under a different name?
If Yes, name:
Are you able to perform the essential functions of the position as listed and described on the attached job description or as demonstrated by the company representative with or without a reasonable accommodation?
Have you ever been convicted of a crime, pled no contest, or been a defendant in a civil action for an intentional tort?
If Yes, list offense, date and disposition of the case (Convictions will not necessarily disqualify you for the position):
Do you have a non-compete agreement or are you subject to any restrictive covenant with any of your former employers?
If Yes, please explain:

EMPLOYMENT INTERESTS

Position Desired: Date Available: Salary Desired:
Type of Employment Desired:
Shift Preference: Manufacturing
Office

EDUCATION INFORMATION

H.S. Name & Location of School Course of Studyl Year Completed Did You Graduate? Degree or Diploma
College Name & Location of School Course of Studyl Year Completed Did You Graduate? Degree or Diploma
Other Name & Location of School Course of Studyl Year Completed Did You Graduate? Degree or Diploma

SKILLS

If applicable for position for which you are applying.

Computer Skills (Indicate software used):
Welding and Fabrication Skills:
Languages Spoken/Written:

EMPLOYMENT INFORMATION

Start with current or most recent employer.  Account for all time periods including unemployment, self-employment and military service.

Employer 1
Company Name: Employer Phone:  
Address:
City: State: Zip Code:
Job Title: Supervisor Name:  
From Mo/Yr: To Mo/Yr:  
Start Pay: End Pay:  
Reason for leaving: May we contact this employer?
 
Duties:

Employer 2
Company Name: Employer Phone:  
Address:
City: State: Zip Code:
Job Title: Supervisor Name:  
From Mo/Yr: To Mo/Yr:  
Start Pay: End Pay:  
Reason for leaving: May we contact this employer?
 
Duties:

Employer 3
Company Name: Employer Phone:  
Address:
City: State: Zip Code:
Job Title: Supervisor Name:  
From Mo/Yr: To Mo/Yr:  
Start Pay: End Pay:  
Reason for leaving: May we contact this employer?
 
Duties:

ACKNOWLEDGMENT

Please read below and check each box to acknowledge you have read that paragraph.

Please leave this field empty.
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