We are an Equal Opportunity Employer

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* 1. Contact Information

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* 2. Home Phone Number

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* 3. Cell Phone Number

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* 4. Employment Desired (Position/s Applying For)

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* 5. Have you ever applied to or worked for
our Company before?

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* 6. If yes, when?

Date / Time

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* 7. Do you have any friends or relatives working for
our Company?

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* 8. If yes, state name(s) and relationship:

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* 9. How did you learn about our Company?

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* 10. If hired, would you have a reliable means of transportation to and from work?

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* 11. Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)

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* 12. If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country?

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* 13. Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

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* 14. If no, describe the functions that cannot be performed. (Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, and to skill and agility tests.) 

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