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Employment Application
Full - Time 2nd Lieutenant
Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
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State
Zip Code
Phone Number
*
Please enter a valid phone number.
Social Security Number
*
Please enter a valid phone number.
E-mail Address
*
Are you 18 years or older
*
Please Select
Yes
No
Are you a citizen of the United States or do you have permission to work in the United States? A U.S. Government form I-9 which requires proof of the right to work is mandatory and will be completed prior to employment.
*
Please Select
Yes
No
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Education
Name of High School
*
Highest Grade Completed
*
Please Select
12
11
10
9
Did you Graduate?
*
Please Select
Yes
No
Name of College, trade, or technical school
Name of College, trade, or technical school
Name
From
To
Course Study
Graduate?
Name
Name
Name
Name
Name
Name
Name
Name
Highest year of College, trade, or technical school completed?
Please Select
1
2
3
4
5
6+
Are you a Veteran of the United States Armed Forces?
*
Please Select
Yes
No
If yes, which branch?
Type of Discharge?
Date of Discharge?
Rank and Specialty at time of Discharge
Are you presently a member of the Armed Forces Reserves?
Please Select
Yes
No
If yes, which branch?
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Previous Employment (A)
Most Recent First
Employer
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Work Performed
Date of Hire
Date of Departure
Name of Supervisor
Phone Number
Please enter a valid phone number.
Weekly Pay
Reason for leaving
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Previous Employment (B)
Most Recent First
Employer
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Work Performed
Date of Hire
Date of Departure
Name of Supervisor
Phone Number
Please enter a valid phone number.
Weekly Pay
Reason for leaving
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Previous Employment (C)
Most Recent First
Employer
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Work Performed
Date of Hire
Date of Departure
Name of Supervisor
Phone Number
Please enter a valid phone number.
Weekly Pay
Reason for leaving
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Previous Employment (D)
Most Recent First
Employer
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Work Performed
Date of Hire
Date of Departure
Name of Supervisor
Phone Number
Please enter a valid phone number.
Weekly Pay
Reason for leaving
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Information about yourself
Use the space below to tell us any information in which you feel would be useful as an aid in determining your fitness for the position for which you are applying for. You may wish to include volunteer or other uncompensated work experience, informal training, self-study, hobbies, work experience not shown elsewhere on the application, etc.
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Reference 1
List in the space provided below the names of three persons living in the United States and not related to you, preferably persons with whom or for whom you have worked, or who have knowledge of your experience and fitness for the position in which you are applying for.
Full Name
*
Business or Occupation
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Relation to you (Supervisor, Friend, etc.)
*
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Reference 2
List in the space provided below the names of three persons living in the United States and not related to you, preferably persons with whom or for whom you have worked, or who have knowledge of your experience and fitness for the position in which you are applying for.
Full Name
*
Business or Occupation
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Relation to you (Supervisor, Friend, etc.)
*
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Reference 3
List in the space provided below the names of three persons living in the United States and not related to you, preferably persons with whom or for whom you have worked, or who have knowledge of your experience and fitness for the position in which you are applying for.
Full Name
*
Business or Occupation
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Relation to you (Supervisor, Friend, etc.)
*
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Please Upload Certifications
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