Apply Step 1 of 7 14% PERSONAL INFORMATIONDate Name Last Name First Name Middle Street City State Zip Phone NumberSocial Security Number Relatives employed by AM Haire? Referred By (If Applicable) How did you hear of us?(Required) Are you a US citizen or can provide documentation authorizing you to work in the US? No Yes Are you 18 years or older? Yes No Birthdate Single Yes Married Yes Have you ever been convicted of a Felony? Yes No If yes please describe in details EMPLOYMENT DESIREDPosition Date You Can Start Salary Desired Are you currently employed? if so may we contact your employer? Have you ever applied to this company before? Where? When? Resume uploadMax. file size: 100 MB. PREVIOUS EMPLOYERS (LIST YOUR LAST THREE EMPLOYERS BEGINNING WITH MOST RECENT)Employer Name & Address 1 Phone Number 1 Your Position & Duties 1 Dates of Employment 1 Salary 1 Supervisor's Name 1 Reason for Leaving 1 Employer Name & Address 2 Phone Number 2 Your Position & Duties 2 Dates of Employment 2 Salary 2 Supervisor's Name 2 Reason for Leaving 2 Employer Name & Address 3 Phone Number 3 Your Position & Duties 3 Dates of Employment 3 Salary 3 Supervisor's Name 3 Reason for Leaving 3 EDUCATIONHigh School Name & location Date You Graduated 1 Course Of Study 1 College Name & Location Date You Graduated 2 Course Of Study 2 Trade/Business School Name & Location Date You Graduated 3 Course Of Study 3 Subjects of Special Study or Research Work US Military or Naval Service Rank When? Present Membership in National Guard or Reserves PERSONAL REFERENCESPersonal Reference Name Personal Reference Address Personal Reference Phone Personal Reference Name 2 Personal Reference Address 2 Personal Reference Phone 2 Personal Reference Name 3 Personal Reference Address 3 Personal Reference Phone 3 PHYSICAL RECORDDo you have any physical limitations that prevent you from performing any work for which you are being considered? Yes No If yes what can be done to accommodate your limitation? EMERGENCY CONTACTEmergency Contact Name Emergency Contact Relation Emergency Contact Phone **I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. Yes I AUTHORIZE INVESTIGATIONS OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU. Yes I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINATE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE** Yes DATE
