Career Opportunities Be Part of the Pro-Cise Team! Application for Employment Fields marked with a * are required. Position Applied for: Date of Application: Basic Information Full Name: * Address: * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Email: * Telephone: * More Information If you are under 18, can you furnish a work permit? * YesNo Have you ever been employed here before? * YesNo Are you legally eligible for employment in this country? * YesNo Date available to work? * Shift desired: * 6 a.m. to 4:30 p.m. Monday through Thursday4:15 p.m. to 2:45 a.m. Monday through Thursday Are you able to meet the attendance requirements of the position? * YesNo Have you been convicted of a felony in the past seven (7) years? * YesNo Driver's license number (if job related) State: * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Employment History Start with most recent on top. From To Employer Telephone Job Title Employer Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving Hourly Rate/Salary Start $ hourlysalary Final $ hourlysalary From To Employer Telephone Job Title Employer Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving Hourly Rate/Salary Start $ hourlysalary Final $ hourlysalary From To Employer Telephone Job Title Employer Address Immediate Supervisor and Title Summarize the nature of work performed and job responsibilities Reason for Leaving Hourly Rate/Salary Start $ hourlysalary Final $ hourlysalary Skills and Qualifications Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our company. Educational Background (if job related) * Name and Location Years Completed Did you graduate? Course of Study High School Name and Location Years Completed Did you graduate? Course of Study College Name and Location Years Completed Did you graduate? Course of Study Other Name and Location Years Completed Did you graduate? Course of Study Other Name and Location Years Completed Did you graduate? Course of Study References Name Telephone Years Known Name (Reference one) Telephone (Reference one) Years Known (Reference one) Name (Reference two) Telephone (Reference two) Years Known (Reference two) Name (Reference three) Telephone (Reference three) Years Known (Reference three) It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the Employer's service if I have been employed. I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information, and all other persons, corporations or organizations for furnishing such information. The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law. This application is current for only sixty (60) days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary to fill out a new application. I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary. FOR MARYLAND RESIDENTS ONLY: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100. Signature of Applicant * Date *
