Easterseals AK Personnel Application

Personnel Application
Full Name *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Are You a U.S. Citizen? *

Yes No
*If not a U.S. Citizen, a copy of work permit will need to be provided at time of employment.
Do You Own A Car? *

Yes No
Do You Have A Drivers License? *

Yes No
Distance Willing To Travel? *
What Languages Do You Speak?
In Case of Emergency, Notify:
Name & Relationship
Emergency Contact Phone Number

Area Code Phone Number
Activities / Interests
List some activities and interests that you have.

Skills/Qualifications:
Additional Training *
List further training which you have received in business, technical, nursing, service schools, colleges or by correspondence.
Certificates or Licenses Held:
List any relevant certifications or qualifications

References:

We require three references from persons who have known you for three years or more. *References may not be family members.
Reference 1 *
Name of Reference
Relationship *
Relationship to applicant
Years Acquainted *
Phone Number *

Area Code Phone Number
Email *
For reference letter purposes
Reference 2 *
Name of Reference
Relationship *
Relationship to applicant
Years Acquainted *
Phone Number *

Area Code Phone Number
Email *
For reference letter purposes
Reference 3 *
Name of Reference
Relationship *
Relationship to applicant
Years Acquainted *
Phone Number *

Area Code Phone Number
Email *
For reference letter purposes

Cover Letter & Resume:
Cover Letter
Resume
Send Application:
By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed by one of our affiliates, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to Easterseals Alaska's rules and regulations.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
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