Location: |
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| Personal Data |
First Name: |
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Last Name: |
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Middle Initial : |
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Internet E-mail: |
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Telephone Number: |
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Address: |
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City: |
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State: |
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Zip: |
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| Employment Information |
Position(s) Applied For:
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Salary Desired?: |
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Soc. Security #: |
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Are you 18 years of age or over?: |
Yes:
No: |
If not, what is your age?: |
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Are you legally authorized to work in the United States?: |
Yes:
No: |
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Have you ever been employed by or previously applied to Bouldercreek or any of its subsidiaries? If so, please check the appropriate box and specify location(s) and date(s).
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How were you referred to Bouldercreek?: |
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Can you carry 50 pounds a distance of 50 feet with or without
reasonable accommodation?:
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Yes: No: |
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The following conditions may be required as part of
a job assignment. If required, would you be willing to work:
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A. Shift work?:
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Yes: No: |
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B. Rotational work schedule?:
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Yes:
No: |
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C. Work schedule other than Monday thru Friday?:
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Yes: No: |
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D. Overtime work?:
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Yes: No: |
When could you be available to begin work?: |
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Type of employment desired: |
Regular:
Part-Time:
Temporary:
Summer:
Cooperative Education: |
| Education And Training |
Did you graduate high school?: |
Yes: No: |
What high school?: |
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Did you graduate college?: |
Yes: No: |
If so, what college?: |
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Please list all Degrees, Diplomas, Certificates, Majors, Minors, and Fields of Study: |
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| Security Data |
Have you ever been convicted of a felony?: Yes: No: |
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If yes, please briefly describe the circumstances of your
conviction, indicating the date, nature, and place of the offense and
disposition of the case. A conviction will not necessarily disqualify
an applicant from employment since this will be looked upon as only
one of the factors considered in the employment decision and is
evaluated in terms of the nature, severity, and date of the
offense.
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| Employment Experience |
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Please list your last four employers. Start with your present
status and note any periods in which you were not employed. Include
U.S. military service, previous Bouldercreek experience,
summer/part-time jobs, and cooperative education assignments.
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This application Will Receive Active Consideration for
Thirty Days.
*Bouldercreek does not discriminate in hiring or employment on the basis of
race, color, religion, national origin, sex, age, disability or veteran
status. No question on this application is intended to secure information to
be used for such discrimination.