Check all that apply.
First Name *
Last Name *
Primary Phone *
Secondary Phone
Street Address *
City *
State *
Zip Code *
Email
Social Security Number *
In 200 words or less, describe the skills you have that would make you ideal for this position. (200 chars left)
(Including drivers) or certifications to practice a trade or profession.
Do you have a high school equivalency diploma? Yes No
Number of years of post high school education 0 1 2 3 4
If you plan to complete an educational program in the future, then indicate the degree or program to be completed and expected date of completion. (100 chars left)
Which shift are you willing to accept? Day Evening Night Rotating Weekends *
Specify shifts hours:
Which job status are you willing to accept? Full Time Part Time *
When will you be available to start work? If you are available as soon as you given two weeks notice, then no dates are necessary.
Please note that under the Immigration Reform and Control Act of 1986, that you may be required to fill out a certification verifying that you are eligible to be employed and verifying your identity. You may also be required to provide documentation that you should be employed.
Compliance with the Immigration Reform and Control Act requires that you are legally eligible for employment in the United States? Yes No *
Are you a veteran who received an honorable discharge and has: a. Provided more than 180 consecutive days of full time active duty in the armed forces of the United States or reserve components, including more than the National Guard? Or, b. Have a military service disability rating fixed by the United States Veterans Affair? Yes No
If yes to the above question, did you serve during the Vietnam Conflict (2/28/61-3/7/75)? Yes No
I understand that by submitting (printing) my name I hereby certify that all entries on this job application and any attachments are true and complete. I also agree and understand that any falsification of this information may result in my forfeiture of employment.
I further understand that by submitting (printing) my name on this job application it is subject to verification and I consent to criminal history and background checks. I also agree that you may contact referecnes and educational institutions listed on this application.
Dated *
Job Application Signature
Thank you for applying to Richland District 88a.
