AClear Corporation
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Application For Employment
Applicants May Be Tested For Illegal Drugs
Please complete all sections
Date:
Name
::
Last
First
Middle
Maiden
Present Address:
Number
Street
City
State
Zip
How Long:
Phone Number:
(
) -
-
Social Security Number:
-
-
If under 18, please list age:
Position applied for:
Salary desired
(Be Specific)
Days/hours available to work:
No Pref.
Thurs .
Mon.
Fri .
Tues.
Sat.
Wed.
Sun .
How many hours can you work weekly?
Can you work nights?
Yes /
No
Employment Desired:
Full Time Only /
Part Time Only /
Full - or Part Time
When are you available for work:
Education History
Type of School
Name of School
Location(Complete Mailing Address)
Number of years completed
Major & Degree
High School
College
Bus. or Trade School
Professional School
Have you ever been convicted of a crime?
Yes /
No
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:
Do you have a drivers license?
Yes /
No
What is your means of transportation to work?
Drivers License Number:
State of issue:
Date of expiration:
Operator /
Commercial /
Chauffeur
Have you had any accidents during the past three years?
Yes /
No - If yes, how many:
Have you had any moving violations during the past three years?
Yes /
No - If yes how many:
Please list two references other than relatives or previous employers:
Name:
Position:
Company:
Address:
City, State, Zip
Telephone
Name:
Position:
Company:
Address:
City, State, Zip
Telephone
An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualificaiotns for the specific position for which you are applying:
Have you been in the Armed Forces?
Yes /
No
Are you now a member of the National Guard?
Yes /
No
Speciality:
/ Date Entered:
/ Discharge Date:
Work Experience:
Please list your work experience for the past five years beginning with your most recent job held.
If you were self-employed, give firm name.
Position 1
Name of Employer:
Job Title :
Address:
City, State, Zip
Telephone
Name of Supervisor
Employment Dates:
From:
To:
Pay or Salary:
Start:
Final:
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
Position 2
Name of Employer:
Job Title :
Address:
City, State, Zip
Telephone
Name of Supervisor
Employment Dates:
From:
To:
Pay or Salary:
Start:
Final:
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
Position 3
Name of Employer:
Job Title :
Address:
City, State, Zip
Telephone
Name of Supervisor
Employment Dates:
From:
To:
Pay or Salary:
Start:
Final:
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
Position 4
Name of Employer:
Job Title :
Address:
City, State, Zip
Telephone
Name of Supervisor
Employment Dates:
From:
To:
Pay or Salary:
Start:
Final:
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
Position 5
Name of Employer:
Job Title :
Address:
City, State, Zip
Telephone
Name of Supervisor
Employment Dates:
From:
To:
Pay or Salary:
Start:
Final:
Reason for leaving:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
By clicking the submit button below, you are verifiing that the information contained in the form is true and accurate.