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    Employment Application Form 09

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    api-19987040
    The document is an employment application for Dr. Vonnahme & Associates, LLC. It requests personal information from the applicant such as name, address, phone numbers, availability and qualifications. It also asks for the applicant's employment history, education, skills and references. The applicant must sign certifying that the information is true and authorizing the employer to check references.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as ODT, PDF, TXT or read online from Scribd

    Employment Application Form 09

    Uploaded by

    api-19987040
    127 views3 pages
    The document is an employment application for Dr. Vonnahme & Associates, LLC. It requests personal information from the applicant such as name, address, phone numbers, availability and qualifications. It also asks for the applicant's employment history, education, skills and references. The applicant must sign certifying that the information is true and authorizing the employer to check references.

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    Employment_Application_Form_09

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    The document is an employment application for Dr. Vonnahme & Associates, LLC. It requests personal information from the applicant such as name, address, phone numbers, availability and qualifications. It also asks for the applicant's employment history, education, skills and references. The applicant must sign certifying that the information is true and authorizing the employer to check references.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as ODT, PDF, TXT or read online from Scribd
    Download as odt, pdf, or txt
    127 views3 pages

    Employment Application Form 09

    Uploaded by

    api-19987040
    The document is an employment application for Dr. Vonnahme & Associates, LLC. It requests personal information from the applicant such as name, address, phone numbers, availability and qualifications. It also asks for the applicant's employment history, education, skills and references. The applicant must sign certifying that the information is true and authorizing the employer to check references.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as ODT, PDF, TXT or read online from Scribd
    Download as odt, pdf, or txt
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    The document outlines the information and details required to apply for a position at Dr. Vonnahme & Associates, LLC, including personal details, references, employment history, and certification.

    An employment application requests contact information, emergency contacts, position applying for and salary requirements, availability, skills, education and training history, references, and a certification statement.

    An applicant is responsible for providing truthful, accurate and complete information in their application. They must also authorize their former employers and educational institutions to share details and sign a certification statement.

    EMPLOYMENT APPLICATION

    Employer: Dr. Vonnahme & Associates, LLC


    Address: 50 Holyoke St. Suite 10156
    City/State/Zip: Holyoke, Massachusetts 01041

    It is the policy of Dr. Vonnahme & Associates, LLC to provide equal employment opportunities to
    all applicants and employees without regard to any legally protected status such as race, color, religion,
    gender, national origin, age, disability or veteran status.

    Applicant Name: ___________________________________________


    Address: ___________________________________________
    City/State/Zip: ___________________________________________
    Number of years at this address: _________
    Daytime phone: ____________________ Evening phone: ____________________

    Social Security Number: ___________________________

    Who should be contacted if you are involved in an emergency?


    Contact Name: ___________________________________________
    Relationship to you: ___________________________________________
    Address: ___________________________________________
    City/State/Zip: ___________________________________________
    Daytime phone: ____________________ Evening phone: ____________________

    Job Position Applied For: ____________________________________

    Salary Desired: $ ____________ per ____________

    Referral Source: Who referred you to our company?


    ___________________________________________________________

    Are you at least 18 years old? ______ Yes ______ No

    How will you get to work? _____________________________________

    Driver's License Number: ___________________________


    What state issued your license? ______________________

    Are you willing to work any shift, including nights and weekends?______ Yes ______ No
    If no, please state any limitations:
    ________________________________________________

    If you are offered employment, when would you be available to begin work?
    ____________________________________
    Are you able to perform the essential functions of the job position with
    or without reasonable accommodation? ______ Yes ______ No
    What reasonable accommodation, if any, would you require?
    ________________________________________________

    Have you ever been convicted of any crime, including traffic violations?
    ______ Yes ______ No If yes, please describe:
    ________________________________________________

    THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO


    EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

    Applicant Employment History: List your current or most recent employment first.
    Please explain any gaps in employment longer than 3 months.

    Employer Name: ___________________________________________


    Address: ___________________________________________
    City/State/Zip: ___________________________________________
    Job Duties: ___________________________________________
    Reason for Leaving: ___________________________________________
    Dates of Employment (Month/Year): _____________________________

    Employer Name: ___________________________________________


    Address: ___________________________________________
    City/State/Zip: ___________________________________________
    Job Duties: ___________________________________________
    Reason for Leaving: ___________________________________________
    Dates of Employment (Month/Year): _____________________________

    Employer Name: ___________________________________________


    Address: ___________________________________________
    City/State/Zip: ___________________________________________
    Job Duties: ___________________________________________
    Reason for Leaving: ___________________________________________
    Dates of Employment (Month/Year): _____________________________

    Applicant's Education and Training: List your education and training.

    High School Name and Address


    ____________________________________________________________
    Last Grade? ____ 9 ____ 10 ____ 11 ____ 12 Diploma? ______ Yes ______ No

    College Name and Address


    ____________________________________________________________
    Did you receive a degree? ______ Yes _____ No If yes, degree received: ___________

    Other Training (graduate, technical, vocational):


    ____________________________________________________________

    Awards, Honors, Special Achievements:


    ____________________________________________________________
    Applicant's Skills: Check those skills that you have. List any other skills that may be useful for the job you
    are seeking. Enter the number of years of experience, and circle the number which corresponds to your
    ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

    Skill or Ability Years of Experience Rating


    [ ] Word Processing __________________ 1 2 3 4 5
    [ ] Accounting/Bookkeeping __________________ 1 2 3 4 5
    [ ] Filing __________________ 1 2 3 4 5
    ____________________________ __________________ 1 2 3 4 5
    ____________________________ __________________ 1 2 3 4 5

    References: List any two people who would be willing to provide a reference for you.

    Name: ___________________________________
    Address: ___________________________________
    City/State/Zip: ___________________________________
    Telephone: _______________________
    Relationship: _______________________

    Name: ___________________________________
    Address: ___________________________________
    City/State/Zip: ___________________________________
    Telephone: _______________________
    Relationship: _______________________

    Please provide any other information that you believe should be considered:
    ____________________________________________________________
    ____________________________________________________________

    CERTIFICATION

    I certify that the information provided on this Application is truthful and accurate. I understand that
    providing false or misleading information will be the basis for rejection of my Application, or if
    employment commences, immediate termination.

    I authorize Dr. Vonnahme & Associates, LLC to contact former employers and educational organizations
    regarding my employment and education. I authorize my former employers and educational organizations
    to fully and freely communicate information regarding my previous employment, attendance, and grades. I
    authorize those persons designated as references to fully and freely communicate information regarding my
    previous employment and education.

    I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE
    TO ITS TERMS.

    ____________________________________ _______________
    APPLICANT SIGNATURE DATE

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