Alaska PAC Job Application

Employment Application:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
If necessary for the position, are you older than (select one):*

age 18age 21
Are you legally eligible for employment in the U.S.?*

YesNo
If necessary for the position, are you able to work approved overtime?*

YesNo
Do You Have A Drivers License?*

YesNo
If yes, issuing state for your Driver's License and DL Number:
State / DL# - example: AK1234567
Employment Desired:
Position Applying For*
Select from open positions
Type of position I am seeking:*
Select type of position from options
Date You Can Start*

MonthDayYear
Salary Desired*

What Shifts Are You Available?*

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
8am-5pm
2 -10pm
9am-1pm
1pm-5pm
6pm-9pm

Education:
I have my GED*

YesNo
High School
Name of High School Attended
Graduated?*

YesNoSome High SchoolEnrolled
College
Name of College/University Attended
Graduated?*

YesNoSome CollegeN/AEnrolled
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Graduated?

YesNoSome Graduate SchoolN/AEnrolled
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Graduated?

YesNoSome Trade SchoolN/AEnrolled
Area of Study/Degree

Skills/Qualifications:
Skills*
List any relevant skills for the position
Qualifications*
List any relevant current certifications or qualifications for the position
Are you a veteran?

Current Employment:
Current Employer*
Name of Current Employer or NONE if not Employed
Position*
Salary
Start Date

MonthDayYear
May We Contact?

YesNo
If yes, phone # of supervisor:
Previous Employment:
Previous Employer*
Name of Previous Employer
Position*
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
May We Contact?

YesNo
If yes, phone # of supervisor:
Previous Employer
Name of Previous Employer
Position
Salary
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
May We Contact?

YesNo
If yes, phone # of supervisor:

References:

Please provide 2 professional references (supervisor preferred) and 1 personal references (not relatives).
Reference 1*
Name of Reference
Relationship*
Years Acquainted*
Phone*
Email
Reference 2*
Name of Reference
Relationship*
Years Acquainted*
Phone*
Email
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone
Email

Cover Letter & Resume:
Cover Letter*

Browse Files

Cancelof
Resume*

Browse Files

Cancelof
Cover Letter

Upload a File

Cancelof
Resume

Upload a File

Cancelof
Send Application:
By clicking the submit button below, I cerity 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 employement may be terminated at any time.

In consideration of my employment, I agree to conform to the hired company's rules and regulations, and I agree that my employment and compenstation can be terminated, 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 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.

As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from checking of your references.

If necessary for employment, you may be required to supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreemetn and abide by its terms. I understand and agree to the information shown above.
Signature

Clear
Equal Employment Opportunity: Whle many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This informaiton is optional and failure to provide it will have no affect on your application for employment.

Developed at employer request by the Alaska Department of Labor & Workforce Development, Employment Security Division.

Rev. 8/2010

Employment Application:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume:

Send Application:

EEO Applicant Tracking Sheet