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Application

JOB INFORMATION
Position(s) applied for: *
How did you learn about us? * Advertisement   Friend   Walk-In
Employment Agency   Relative
Website   Other  
PERSONAL INFORMATION
Last Name *
First Name *
Middle Name *
Street Address *
City, State, Zip *
Email Address *
Home Phone *
Cell Phone *
EMPLOYMENT DETAILS
If under 18, can you provide required proof of eligibility to work? * Yes   No   N/A
Have you ever filed an application with us before? * Yes   No
If yes, give date:
Have you ever been employed with us before? * Yes   No
If yes, give date:
Are you currently employed? * Yes   No
May we contact your present employer? * Yes   No
Are you prevented from lawfully becoming employed
in this country because of Visa or Immigration status? *
Yes   No
(Proof of citizenship or immigration status will be required upon employment.)
On what date would you be available for work? *   
Are you available to work: *     Full Time   Part Time   Shift Work   Temporary
Are you currently on "lay-off" status or subject to recall? * Yes   No
Can you travel if a job requires it? * Yes   No
Have you been convicted of a felony within the last 7 years? * Yes   No
If yes, please explain:
EDUCATION
Name of School Course of Study Years Completed Diploma/Degree
Elementary      
High School
University
Post-Graduate
Other (specify)
Describe any specialized training, apprenticeship, skills, and extra-curricular activities:
Describe any job-related training received in the United States Military (if applicable):
EMPLOYMENT EXPERIENCE
Employer *
Address *
Phone *
Title *
Supervisor *
Reason for Leaving *
Dates Employed * From:   To:
Hourly Rate/Salary * Start:   End:
Duties *

Employer
Address
Phone
Title
Supervisor
Reason for Leaving
Dates Employed From:   To:
Hourly Rate/Salary Start:   End:
Duties

Employer
Address
Phone
Title
Supervisor
Reason for Leaving
Dates Employed From:   To:
Hourly Rate/Salary Start:   End:
Duties

Employer
Address
Phone
Title
Supervisor
Reason for Leaving
Dates Employed From:   To:
Hourly Rate/Salary Start:   End:
Duties

List professional, trade, business or civic activities and offices held:
ADDITIONAL INFORMATION
Summarize special job-related skills and qualifications acquired from employment or other experience:
State any additional information you feel may be helpful to us in considering your application:
REFERENCES
Reference #1
Name *
Phone *
Address *
Reference #2
Name *
Phone *
Address *
Reference #3
Name *
Phone *
Address *
APPLICANT'S STATEMENT
I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Please place your digital signature in the box provided below:
  Name: * Date:  
Click the submit button below to send this application to DBS for review.
You will be contacted within 1-2 weeks with additional information.

To request a quote or for more information, please fill out the following form. Or, call our Sales Office at (302) 395-0900.
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