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Wayne Opportunity Center, Inc.
EMPLOYMENT APPLICATION
Please complete the following and submit the
application.
First Name:
M.I.:
Last Name:
Address:
Social Security No.:
Email:
Phone:
Cell:
Date Availabe:
Position Applied for:
Desired Salary: $
Are you a citizen of the United States?
*
Required
Yes
No
If no, are you authorized to work in the US?
Yes
No
Have you ever worked for this company?
*
Required
Yes
No
If so, when?:
High School:
From: _________ To: ___________
Address:
Did you graduate?:
Yes
No
Degree:
College 1:
From: _________ To: ___________
Address:
Did you graduate?:
Yes
No
Degree:
College 2:
From: _________ To: ___________
Address:
Did you graduate?:
Yes
No
Degree:
Professional Reference 1:
Professional Reference 2:
Professional Reference 3:
Profession:
Profession:
Profession:
Contact No.:
Contact No.:
Contact No.:
Employment 1:
From: _________ To: ___________
Address:
Supervisor Name:
Phone
Job Title:
Responsibilities:
Starting Salary:
Reason for Leaving:
Ending Salary:
May we contact your previous supervisor for a reference?
Yes
No
Employment 2:
From: _________ To: ___________
Address:
Supervisor Name:
Phone
Job Title:
Responsibilities:
Starting Salary:
Reason for Leaving:
Ending Salary:
May we contact your previous supervisor for a reference?
Yes
No
Employment 3:
From: _________ To: ___________
Address:
Supervisor Name:
Phone
Job Title:
Responsibilities:
Starting Salary:
Reason for Leaving:
Ending Salary:
May we contact your previous supervisor for a reference?
Yes
No
Have you ever served in the United States Military?
Yes
No
Branch of Service
From: _____ To: _____
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
I certify that my answers are true and complete to the best of my knowlege. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Your Signature
Clear
Submit
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