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Affinity Care Partners

Employment Application
Name:*

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Phone Number:*

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Are you a U.S. citizen:*
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Address:*

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Position Applying for:*
Available start date:

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Desired salary:
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Have you ever been employed by Affinity Care Partners?*
If so, when:

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Highest level of education completed:

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Institution of highest level of education:
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References

Please list two (2) references that are familiar with your work life.
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Years Known:*
Address*

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Reference 2
Name:*

First NameLast Name
Phone Number*

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Years Known:*
Address*

Street Address

Street Address Line 2

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Have you ever been convicted of a felony?
If so, please provide explanation:
Affinity care Partners is an Equal Opportunity Employer and does not discriminate.
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