Employment Application
Please fill out the employment application completely.
First Name (*)
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Middle Name
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Last Name (*)
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Address (*)
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City (*)
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State (*)
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Zip Code (*)
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Phone (*)
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Are you under 18 years of age?
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If yes, enter your birthdate
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How did you learn of this opening? (*)
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Were you previously employed by Antonio's? (*)
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If yes, please list dates, location, position held, and your supervisor's name:
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Are you a US Citizen? (*)
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If no, do you possess an alien registration card?
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Have you ever been convicted of a felony? (*)
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If hired, do you have a reliable means of transportation to get to work? (*)
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Explain
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Do you have any physical condition which may limit your ability to perform the particular job for which you are applying? (*)
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If yes, describe such condition (*)
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Have you had a serious illness or injury in the last 5 years? (*)
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If yes, please explain (*)
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Have you ever received compensation for injuries? (*)
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If yes, explain
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IN CASE OF EMERGENCY, NOTIFY:
Name (*)
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Address (*)
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Phone (*)
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Position Applying for (*)
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Are you interested in working: (*)
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Wage Desired (*)
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Please indicate the days and hours on those days you'd be available to work:
Previous Employment
From (*)
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To (*)
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Starting Salary (*)
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Salary Finish (*)
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Reason for leaving (*)
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Name & Address of Business | Supervisor's Title/Name Phone (*)
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Job Title and Duties (*)
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From (*)
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To (*)
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Starting Salary (*)
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Salary Finish (*)
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Reason for leaving (*)
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Name and Address of Business | Supervisor's Title/Name Phone (*)
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Job Title and Duties (*)
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From (*)
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To (*)
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Starting Salary (*)
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Salary Finish (*)
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Reason for leaving (*)
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Name and Address of Business | Supervisor's Title/Name Phone (*)
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Job Title and Duties (*)
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Military Service
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Dates of Service
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Branch of Service
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Education
High School Name
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Graduate?
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Subjects Studied
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College Name
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Graduate?
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Subjects Studied
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Trade/Business
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Graduate?
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Subjects Studied
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Other
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Graduate?
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Subjects Studied
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References
Reference Name (*)
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Occupation (*)
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Address
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Phone
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Reference Name (*)
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Occupation (*)
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Address
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Phone
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Reference Name
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Occupation
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Address
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Phone
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May we contact the past and/or present employers listed? (*)
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If no, indicate those you do not want us to contact
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If you are known to schools/references by another name, please list it here.
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I authorize investigation of all statements contained in this application, except where I have requested on this form that no investigation be made. I hereby certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause for dismissal. I understand that my employment will be on a probationary basis for the period established for all new employees (45 days), and that regular employment will, at the option of the company, be contingent upon my satisfactorily passing a physical examination, if required.
Enter for full name as an electronic signature (*)
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