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EMPLOYMENT APPLICATION

    What position are you interested in?

    First name

    Middle name

    Last name

    Email

    Phone

    Date available

    Street address

    City

    State

    Zip code

    Desired hourly pay

    Are you at least 18 years old?

    Are you authorized to work in the U.S.?

    Are reasonable accommodations required for you to perfom the essential functions of the job you seek?

    What reasonable accommodations, if any, would you request?

    EDUCATION

    High school attended

    Did you graduate?

    Trade school attended

    List earned certification(s) or degree

    College attended

    List degree earned

    List any other certifications

    MILITARY SERVICE

    Did you serve in the military?

    If yes, what branch?

    Were you honorably discharged?

    List any special training

    List any honors, awards, or special achievements

    SKILLS

    List any skills that may be useful for the job you are seeking. Enter the number of years of experience and click the number which corresponds to your ability level for each particular skill. (One represents modest ability, while five represents exceptional ability.)

    Skill

    Years of experience

    Ability rating

    Skill

    Years of experience

    Ability rating

    Skill

    Years of experience

    Ability rating

    EMPLOYMENT HISTORY

    Please list all jobs beginning with your current or the most recent and list and explain any gaps in employment.

    Company name

    Dates of employment start date

    Dates of employment end date

    Company address, city, state and Zip

    Company phone

    Supervisor

    May we contact for a reference?

    Responsibilities

    Starting title

    Ending title

    Reason for leaving

    Company name

    Dates of employment start date

    Dates of employment end date

    Company address, city, state and Zip

    Company phone

    Supervisor

    May we contact for a reference?

    Responsibilities

    Starting title

    Ending title

    Reason for leaving

    Company name

    Dates of employment start date

    Dates of employment end date

    Company address, city, state and Zip

    Company phone

    Supervisor

    May we contact for a reference?

    Responsibilities

    Starting title

    Ending title

    Reason for leaving

    Company name

    Dates of employment start date

    Dates of employment end date

    Company address, city, state and Zip

    Company phone

    Supervisor

    May we contact for a reference?

    Responsibilities

    Starting title

    Ending title

    Reason for leaving

    ADDITIONAL INFORMATION

    Please explain any gaps in employment or any share other information that you think would be important for us to know about you and your experience.

    CERTIFICATION

    I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application or if employment commences, immediate termination.

    I authorize Abbottstown Industries Inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment attendance and grades.

    If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Vice President, the employment relationship will be “at-will”. The relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause.

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