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Employment Form
Application Information
First Name :
*
Last Name:
*
Address:
*
City:
*
State:
*
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP Code:
*
Home Phone:
(
)
-
First three digits
Second three digits
Last four digits
Cell Phone Number:
(
)
-
First three digits
Second three digits
Last four digits
Message Phone:
Email Address:
Are you 18 years of age or older?:
*
Yes
No
Have you previously worked for Williams Island POA?:
*
Yes
No
If yes, please provide dates, position held, and supervisor's name.:
Are you related to an employee?:
*
Yes
No
If yes, please specify.:
Are you legally authorized to work in the United States?:
*
Yes
No
If required, do you meet the legal age requirement in the state of Florida, to serve/handle alcoholic beverages?:
Yes
No
Have you ever been terminated from a job involuntarily?:
*
Yes
No
Employment Interests
Position Desired:
Availability:
Full - Time
Part - Time
Seasonal
On Call
Date Available:
Date and time
Calendar
Today
Salary Desired:
When are you available for work?:
Days
Evenings
Overnight
Weekends
Holidays
Overtime (if required)
Are there any specific times when you are unable to work?:
Yes
No
If yes, please specify.:
How were you referred to our company?:
Agency
Internet
Walk - in
Re - hire
Employee*
Advertisement*
Other*
For options with *, please specify.:
Educational Background
HIGH SCHOOL
Name & School Location:
Course of Study: :
Last Grade Completed: :
9
10
11
12
Did you graduate? :
Yes
No
Degree / Diploma: :
COLLEGE OR UNIVERSITY
Name & School Location: :
Course of Study: :
Last Grade Completed: :
1
2
3
4
Did you graduate?:
Yes
No
Degree / Diploma: :
POST GRADUATE
Name & School Location: :
Course of Study: :
Last Grade Completed: :
1
2
3
4
Did you graduate? :
Yes
No
Degree / Diploma: :
TRADE OR VOCATIONAL
Name & School Location: :
Course of Study: :
Last Grade Completed: :
1
2
3
4
Did you graduate? :
Yes
No
Degree / Diploma: :
ADDITIONAL INFORMATION
Do you hold any specialized licenses or certifications? :
Yes
No
Option 3
If yes, please specify. :
Do you speak, read, or write any foreign languages? :
Yes
No
Speak: :
Read: :
Write: :
Employment Background
EMPLOYMENT 1
Employer: :
Date Employed From: :
Date Employed To: :
Address: :
City: :
State:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip: :
Supervisor's Name & Title: :
Phone Number: :
(
)
-
First three digits
Second three digits
Last four digits
Job Title: :
Starting Pay Rate:
Ending Pay Rate:
Daily Responsibilities: :
Reason for Leaving:
May we contact employer? :
Yes
No
EMPLOYMENT 2
Employer: :
Date Employed From: :
Date Employed To: :
Address: :
City: :
State:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Supervisor's Name & Title: :
Phone Number: :
(
)
-
First three digits
Second three digits
Last four digits
Job Title: :
Starting Pay Rate: :
Ending Pay Rate: :
Daily Responsibilities:
Reason for Leaving: :
May we contact employer? :
Yes
No
EMPLOYMENT 3
Employer: :
Date Employed From: :
Date Employed To: :
Address: :
City: :
State: :
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip: :
Supervisor's Name & Title: :
Phone Number: :
(
)
-
First three digits
Second three digits
Last four digits
Job Title: :
Starting Pay Rate: :
Ending Pay Rate: :
Daily Responsibilities: :
Reason for Leaving: :
May we contact employer? :
Yes
No
EMPLOYMENT 4
Employer: :
Date Employed From: :
Date Employed To: :
Address: :
City: :
State: :
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip: :
Supervisor's Name & Title: :
Phone Number: :
(
)
-
First three digits
Second three digits
Last four digits
Job Title: :
Starting Pay Rate: :
Ending Pay Rate: :
Daily Responsibilities: :
Reason for Leaving: :
May we contact employer? :
Yes
No
Acknowledgment
Please read carefully and check the box next to each paragraph.
* I understand that Williams Island POA and/or the employing entity is an equal opportunity employer and selects individuals best matched for the job based on job-related qualifications regardless of race, color, religion, sex, national origin, sexual orientation, age, or disability. :
* I understand that this application will be given every consideration and will be kept on active status for sixty days, but it is not a promise of employment. Any applicant wishing to be considered for employment beyond sixty days should re-apply. :
* I understand that employment is at will. It can be terminated, with or without cause or notice at any time, at the option of either Williams Island POA or myself. No manager or supervisor had the authority to enter into an employment agreement for any specific period of time or to make agreement contrary to the foregoing without the direct authorization of Williams Island POA. :
* In the processing of my application, an investigation will be made whereby information is obtained from former employers and references. Permission is hereby granted to any school, person, firm or corporation, whether my former employer or otherwise, to give Williams Island POA, its officers, employees, representatives, or agents information regarding my employment or educational history. Any entity providing information will not be held liable for any damage incurred by myself through the release of requested information. :
* I understand that I will be required to complete a pre-employment drug screening examination administered by a professional laboratory as part of my application for employment to which I also consent. I understand that either refusal to submit to the pre-employment drug screening examination or failure to qualify according to the standards established by the Company for this examination may disqualify me from further consideration for employment. The results of this examination shall be held in confidence and furnished only to the authorized officer of the Company from which I am now seeking employment for use solely in consideration relevant to my employment. I further understand that upon commencement of employment with the Company I may again be required, for reasonable suspicion, or randomly, to submit to a drug screening examination administered by a professional laboratory. I understand that refusal to take a requested drug screening test or failure to meet the standards set for the examination may result in immediate suspension or discharge. :
* Should I be employed, I understand that such employment will be on a trial probationary period for ninety days from the first date of employment. I further understand that my employment will not result in an employment con- tract for any specific term. :
* I agree that the Company can withhold wages to cover any shortages or damages that Iam responsible for. :
* I understand that if hired, my continued employment is predicated upon the truthfulness and accuracy of the statements contained herein, and that I am subject to termination if any statement in this application is false or misleading. :
I HEREBY AFFIRM THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.
Applicant Signature: :
*
Date: :
*
Date and time
Calendar
Today