Application for Employment

= Required Information

Announcements

Your application will not be submitted if there is missing or incomplete information.

Personal Information

Print Name

*First Name		Middle Name		*Last Name		Suffix
Maiden Name

Permanent Address

*No. and Street Name	*City	*State	*Zip
*Preferred Phone	Home Phone	Mobile Phone	Work Phone
*Preferred Email	Personal Email	Work Email

In Case of Illness or Emergency, Etc., Please Notify:

*Name		*Mobile Phone		*Email

Applicant's under age 18 must complete:

Parent/Guardian First Name		Parent/Guardian Last Name		Mobile Phone		Email

Job Interest

*Position Desired:
Other positions for which you may be qualified:
Do you have any relatives employed by the Center?:
If so, Who?:
*What interested you in Working at the Center
Relationship to Primary Contact: Self

Training

High School

*Name		*Location		*Course
*Degree		*Year Graduated		*Class Standing

College

*Name		*Location		*Course
*Degree		*Year Graduated		*Class Standing

Graduate School, Apprentice, Business or Vocational

Name		Location		Course
Degree		Year Graduated		Class Standing

Other Training

Other Training Skills, Special Courses, Factory or Office Machines:
Hobbies

Military Service

Military Branch of Service	Military Service Number		Military Date Entered	[ 10/23/2019 ]
Military Final Rank	Military Discharge Date	[ 10/23/2019 ]	Military Discharge Reason
Military Discharge Status	Military School Special Exp		Military Reserve Status

Employment History

Current Job

*Business Name		Address and Phone Number:
Date From:		Date To:
Starting Salary:		Ending Salary:
Describe Major Job/Duties		Reason for Leaving

Prior Job 1

Business Name		Address and Phone Number:
Date From:		Date To:
Starting Salary:		Ending Salary:
Describe Major Job/Duties		Reason for Leaving

Prior Job 2

Business Name		Address and Phone Number:
Date From:		Date To:
Starting Salary:		Ending Salary:
Describe Major Job/Duties		Reason for Leaving

Prior Job 3

Business Name		Address and Phone Number:
Date From:		Date To:
Starting Salary:		Ending Salary:
Describe Major Job/Duties		Reason for Leaving

If hired, you will be required to submit documentation, within three business days of commencing employment to ensure that you are authorized to work in the United States.

Do you have the legal right to work in the United States?

Reference Information (Name three people, not relatives, who have known you for the past five years.)

Reference 1 Name		Reference 1 Address
Reference 1 Phone Number		Reference 1 Years Known

Reference 2 Name		Reference 2 Address
Reference 2 Phone Number		Reference 2 Years Known

Reference 3 Name		Reference 3 Address
Reference 3 Phone Number		Reference 3 Years Known

Have you ever been convicted of or plead guilty or no contest to a crime or offense, including sex related or child abuse related offenses, excluding minor traffic offenses and disorderly persons offenses except those involving moral turpitude and gambling offenses? (Note: a conviction/guilty plea etc. will not necessarily disqualify you from the job for which you are applying)

Response to above statement:	Date:	[ 10/23/2019 ]
City, State:	Charge:
Disposition:

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Equal Employment Opportunity Statement

The Center for Aquatic Sciences is committed to a policy of equal employment opportunity. All aspects of employment are governed and administered on the basis of merit, qualifications and competence and are not influenced or in any manner affected by race, color, age, sexual preference, national origin or ancestry, religion, disability, marital status or any other classification protected by law.

Application Certification

By clicking the "submit application" button below, you certify that the above information is true. Any false statement will be sufficient reason for dismissal. I authorize you to make inquiry of any of my former employers or other sources as to my experiences, character, habits or reasons for leaving, and authorize such person to companies to release such information without liability.

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