Test

Employee Information

Hidden

Name(Required)
Address(Required)
Date of Birth(Required)
Marital Status
U.S. Citizen?(Required)
Are you able to perform the essential functions of the position?(Required)
Work overtime?(Required)
Seeking a permanent position?(Required)
days after being notified I am hired.

EMPLOYEE HISTORY

List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in the summary following this section or on an extra sheet of paper if necessary. No more than 10 years history recommended.

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EDUCATION

High School Collage/Universty Business/Technical Additional

MILITARY

Are you a veteran?(Required)

SKILLS & QUALIFICATIONS

REFERENCES

List two personal references who are not relatives or former supervisors.

Name(Required)
Address(Required)
Name(Required)
Address(Required)

CONTACT

In case of accident or illness, please contact:

Name(Required)
Address(Required)

INFORMATION TO THE APPLICANT

As part of our procedure for processing your employment application, your personal and 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 United States, 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.

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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. Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division.