Employment

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Are you able to provide a valid Alaska Drivers License?*

Yes

Are you legally eligible for employment in the U.S.A.?*

If yes, verification will be required.

Yes

Are you seeking a permanent position?*

Yes

Are you able to perform the essential functions of the position with or without accommodations?*

Yes

If necessary for the job, are you over the age of:*

List last employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here or in the summary (next section).

Employer Name 1

Address

Street Address City State / Province / Region

Position Title/Duties and Skills

Employment Dates

From To

Reason for leaving

Supervisor

Name Phone Number

Employer Name 2

Address

Street Address City State / Province / Region

Position Title/Duties and Skills

Employment Dates

From To

Reason for leaving

Supervisor

Name Phone Number

Do you need more space for employment history?

Yes

Employer Name 3

Address

Street Address City State

Position Title/Duties and Skills

Employment Dates

From To

Reason for leaving

Supervisor

Name Phone Number

Employer Name4

Address

Street Address City State

Position Title/Duties and Skills

Employment Dates

From To

Reason for leaving

Supervisor

Name Phone Number

Summarize any other employment and/or additional information related to your application:

Information to the applicant: As part of our procedure for processing your employment application, your employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.

If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the US, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms.

I understand and agree to the information shown above:

Electronic Signature*

Date*

Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.

Employment Application

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Employment

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