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APPLICATION FOR EMPLOYMENT

APPLICANT INFORMATION
This is a pre-employment application for Adoption S.T.A.R.  Please answer all of the questions. Any falsification or omission of information is grounds for termination of the application procedures or termination of employment.  We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis including race, color, age, sex, religion, disability or national origin.
First Name*
Last Name*
Middle Initial
Street Address*
Street Address Line 2
City*
State/Region*
Enter Region
Zip Code*
Email Address*
Day Phone*
()-ext
Enter Int'l Number
Cell Phone Number
()-ext
Enter Int'l Number
Referred By:*
EMPLOYMENT DESIRED
  Position* Date You Can Start* Salary Desired*  
  Calendar $  
  Type of Employment* Have You Ever Applied to Adoption STAR Before?* If So, For What Position?* If So, When?*  
    * *  
  Are You Employed Now?* If So, May We Contact Your Present Employer?*  
  *  
EDUCATION
  High School* Address, city, state, zip*  
   
  From* To* Did you graduate?* Degree*  
  Calendar Calendar  
  College Address, city, state, zip  
   
  From To Did you graduate? Degree  
  Calendar Calendar  
  Other Address, city, state, zip  
   
  From To Did you graduate? Degree  
  Calendar Calendar  
PREVIOUS EMPLOYMENT
List present or most recent position first.
  Organization* Telephone*  
   
  Address, city, state, zip* Supervisor*  
   
  Job Title* Starting Salary* Ending Salary*  
  $ $  
  Responsibilities*  
   
  From* To* Reason for Leaving*  
  Calendar Calendar  
  May we contact your previous supervisor for a reference?*  
   
  Organization Telephone  
 
()-ext
Enter Int'l Number
 
  Address, city, state, zip Supervisor  
   
  Job Title Starting Salary Ending Salary  
  $ $  
  Responsibilities  
   
  From To Reason for Leaving  
  Calendar Calendar  
  May we contact your previous supervisor for a reference?  
   
  Organization Telephone  
 
()-ext
Enter Int'l Number
 
  Address, city, state, zip Supervisor  
   
  Job Title Starting Salary Ending Salary  
  $ $  
  Responsibilities  
   
  From To Reason for Leaving  
  Calendar Calendar  
  May we contact your previous supervisor for a reference?  
   
References
  1. Full Name* Relationship*  
   
  Company* Phone*  
 
()-ext
Enter Int'l Number
 
  Address*
Street Address, City, State, Zip
Email*  
   
  2. Full Name* Relationship*  
   
  Company* Phone*  
 
()-ext
Enter Int'l Number
 
  Street Address, City, State, Zip* Email*  
   
  3. Full Name* Relationship*  
   
  Company* Phone*  
 
()-ext
Enter Int'l Number
 
  Address*
Street Address, City, State, Zip
Email*  
   
  4. Full Name Relationship  
   
  Company Phone  
 
()-ext
Enter Int'l Number
 
  Address
Street Address, City, State, Zip
Email  
   
  5. Optional: Full Name Relationship  
   
  Company Phone  
 
()-ext
Enter Int'l Number
 
  Street Address, City, State, Zip Email  
   
GENERAL
  Special Courses or Training*  
   
  Experience/Skills Related to the Position for Which You Are Applying*  
   
  Languages You Speak Other Than English  
   
  Have You Been Convicted of a Felony Within the Last Five Years?*  
   
  If Yes, Describe in Detail*  
  *  
OFFICE APTITUDE
DATA ENTRY
Years of Experience
Words Per Minute
Software Used
KEYBOARDING
Years of Experience
Words Per Minute
Software Used
SHORTHAND
Years of Experience
Words Per Minute
Software Used
TABLES/CHARTS
Years of Experience
Words Per Minute
Software Used
OTHER
Years of Experience
Words Per Minute
Software Used
RESUME
Upload your resume
 
AUTHORIZATION
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein. I authorize the references and employers listed here to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the agency from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of this agency has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing unless it is in writing and signed by an authorized agency representative.
 
 
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