Application Information
Name
*
First Name
Middle Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date Available
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Wage Desired
Position Applied For
Driver License Number
Are you a citizen of the United States?
YES
NO
If yes, License #
Do you have a valid Maine driver’s license?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Have you ever worked for this company?
*
YES
NO
If so, when
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How did you hear about this job opening?
*
Facebook
TV
Radio
Website
Craigslist
Indeed
Referred By
Education
High School
High School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Did you graduate
YES
NO
Degree
College
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Did you graduate
YES
NO
Degree
Other Special Skill or Training
References
Please list three references
Full Name
First Name
Last Name
Relationship
Company
Phone
-
Area Code
Phone Number
Full Name
First Name
Last Name
Relationship
Company
Phone
-
Area Code
Phone Number
Full Name
First Name
Last Name
Relationship
Company
Phone
-
Area Code
Phone Number
Previous Employment
*Giving Wage Info is Optional
Company
Phone
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor
Job Title
Responsibilities
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor
Job Title
Responsibilities
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reasons for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Employer Company
Employer Phone
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor
Job Title
Responsibilities
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Leaving
May we contact your previous supervisor for a reference
YES
NO
Military Service
Branch
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rank at Discharge
Type of Discharge
If other than honorable, explain
Accommodations
Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodations?
YES
NO
Accommodations required, if any
Disclaimer and Signature
I certify all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can beterminated, with or without cause, and with or without notice, at any time, at either my or the company’s option. I also understand and agree that theterms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I alsounderstand and agree that the information submitted may be used to obtain my motor vehicle records, criminal history records, and to review the statesex offender registry as required by company policy and job specific contractual obligations.
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please verify that you are human
*
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