Massachusetts job Application Form 1 - Free Download
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Massachusetts job Application Form 1
Massachusetts job Application Form 1
POSITION APPLIED FOR:_________________________________________________
TODAY’S DATE: _________________________________________________________
NAME: _________________________________________________________________
LAST FIRST MI
HOME PHONE: ______________________WORK PHONE:______________________
CURRENT ADDRESS: ____________________________________________________
STREET
_______________________________________________________________________________________
CITY STATE ZIP
PRIOR ADDRESS: ____________________________________________________
STREET
_______________________________________________________________________________________
CITY STATE ZIP
T Ye s T No Have you been given a job description or had the essential functions of the job explained to you
T Ye s T No Do you understand these essential functions
T Ye s T No After carefully reviewing the job description and physical requirements of the job for which you are applying, are you able to
perform the essential function sof the job with or without reasonable accommodation
JOB-RELATED SKILLS
EMPLOYMENT
APPLICATION
APPLICANT INSTRUCTIONS
Individuals who need assistance with any phase of the
application process should notify the person who gave them
the application to request a reasonable accommodation.
1. Complete all four pages.
2. Print clearly: incomplete or illegible applications will not
be processed. PLEASE NOTE “NOT APPLICABLE” IF
NOT ANSWERING A QUESTION.
3. Provide only requested information. Failure to do so
may result in disqualification of your application.
4. Some packets may include an EEOC Self Identification
Form. This information is being gathered for affirmative
action under Section 503 of the Rehabilitation Act of
1973. The information requested is voluntary and will
be kept confidential. An applicant will not be subject
to any adverse treatment for refusing to complete the
questionnaire.
What date can you start____________________ What category would you prefer T Full time T Part time T Temporary T Labor pool
For which schedules are you available* T Weekdays T Weekends T Evenings T Nights T Overtime T Shift T Other ________
*Reasonable efforts will be made to accommodate sincerely held religious beliefs.
AVAILABILITY
NAME ADDRESS/PHONE YEARS KNOWN/RELATIONSHIP
1.
2.
Include only individuals familiar with your work ability. Do not include relatives or names of supervisors listed.
REFERENCES
NAME CITY/STATE GRADUATED DEGREE TYPE
HIGH SCHOOL
COLLEGE
OTHER
Please circle highest grade completed. 7 8 9 10 11 12 13 14 15 16 16+
If your school records are under a different name than listed on page 1, please enter that name____________________________________________
EDUCATION
T Yes T No
T Yes T No
T Yes T No
3.
PROFESSIONAL LICENSES AND CERTIFICATIONS
T Ye s T No Are you licensed/certified for the job applied for
Name of license/certifications________________________________________________________________________________________________
License/certification number:_______________________________________________________ Issuing State: _____________________________
T Ye s T No Has your license/certification ever been revoked or suspended
If yes, state the reason(s), date of revocation or suspension, and date of reinstatement: __________________________________________________
________________________________________________________________________________________________________________________
© ADP SCREENING & SELECTION SERVICES 2008 VS 1-08
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