JLW PLACE INC.
P.O. BOX 497
SARALAND, AL36571
APPLICATION FOR EMPLOYMENT
GENERAL
POSITION APPLIED FOR ______DATE ______
LAST NAME ______FIRST NAME ______
ADDRESS ______
TELEPHONE NUMBER ______
ALTERNATE NUMBER ______
BEST TIME TO CONTACT YOU ______
ARE YOU AVAILABLE TO WORK ______
(Part time; full time; as needed)
WHAT SHIFT ARE YOU AVAILABLE TO WORK ______
CAN YOU WORK OVERTIME? ______
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EDUCATION
GIVE A BRIEF EDUCATION HISTORY / CERTIFICATIONS: ______
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JLW’S PLACE INC CONT.
WORK EXPERIENCE
EMPLOYER ______
ADDRESS ______
TELEPHONE NUMBER ______
REASON FOR LEAVING ______
FROM: ______TO: ______
EMPLOYER ______
ADDRESS ______
TELEPHONE NUMBER ______
REASON FOR LEAVING ______
FROM: ______TO: ______
EMPLOYER ______
ADDRESS ______
TELEPHONE NUMBER ______
REASON FOR LEAVING ______
FROM: ______TO: ______
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QUESTIONNAIRE
LIST EMERGENCY CONTACT AND NUMBER: ______
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ARE YOU CURRENTLY EMPLOYED? IF YES, HOW LONG? ______
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(JLW’S PLACE INC. CONT.)
IF YOU ARE CURRENTLY NOT EMPLOYED, PLEASE EXPLAIN. ______
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DO YOU HAVE RELIABLE TRANSPORTATION? ______
HAVE YOU EVER WORKED WITH INDIVIDUALS WITH DISABILITIES? PLEASE EXPLAIN.
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HAVE YOU EVER BEEN TERMINATED FROM ANY JOB OR POSITION? EXPLAIN.
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HAVE YOU EVER BEEN CHARGED OR CONVICTED OF A FELONY? ______
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DO YOU HAVE ANY PENDING CHARGES? ______
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ARE YOU INVOLVED IN ANY CURRENT LITIGATION OR INVESTIGATION? ______
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DO YOU HAVE ANY LIMITATIONS THAT WILL HINDER YOUR JOB PERFORMANCE?
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ARE YOU CURRENTLY A STUDENT? ______
DO YOU HAVE ANY PROFESSIONAL LICENSES? ______
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(JLW’S PLACE INC. CONT.)
DESCRIBE YOURSELF IN ONE WORD? ______
WHAT ARE YOU HOBBIES? ______
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WHAT MAKES YOU THE BEST APPLICANT FOR THE POSITION? ______
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PLEASE LIST ANY SPECIALIZED TRAINING, SKILLS, APPRENTICESHIP, AND / OR EXTRA-CURRICULAR ACTIVITIES
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LIST THREE PROFESSIONAL REFERENCES (NAME / ASSOCIATION / PHONE NUMBER)
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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 SHAL BE CONSIDERED ACTIVE FOR A PERIOD OF 90 DAYS. ANY APPLICANT WISHING TO BE CONSIDERED FOR EMPLOYMENT BEYOND THIS TIME PERIOD SHOULD REAPPLY. I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, UNLESS OTHERWSE DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION IS OF A “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 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.
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PRINT DATE
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SIGNATURE DATE