Pelagie Foundation Employment Application
Applicant Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Position Applying For
*
Desired Start Date
*
-
Month
-
Day
Year
Date
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EMPLOYMENT ELIGIBILITY
Have you ever worked for the Pelagie Foundation before?
*
Please Select
Yes
No
if yes, when?
*
-
Month
-
Day
Year
Date
Do you have a valid driver’s license?
*
Please Select
Yes
No
Are you able to pass a background check?
*
Please Select
Yes
No
School Name
*
Degree
*
Major
*
Dates Attended
*
EMPLOYMENT HISTORY
(Most Recent First)
Company Name 1
Position Held
Dates of Employment
-
Month
-
Day
Year
From
Dates of Employment
-
Month
-
Day
Year
To
Supervisor’s Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Reason for Leaving
Company Name 2
Position Held
Dates of Employment
-
Month
-
Day
Year
From
Dates of Employment
-
Month
-
Day
Year
To
Supervisor’s Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Reason for Leaving
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SKILLS AND QUALIFICATIONS
Please list any relevant certifications, skills, languages spoken, or special qualifications
*
REFERENCES
Please list three professional references who are not related to you
Reference 1
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Reference 2
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Reference 3
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
AUTHORIZATION AND ACKNOWLEDGMENT
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that any false or misleading information may result in my release.
Signature
*
Date
*
-
Month
-
Day
Year
Date
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