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Employment Application
  1. Date:(*)
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  2. First Name:(*)
    Please enter your first name
  3. Last Name:(*)
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  4. Street Address(*)
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  5. Apartment/Unit #
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  6. City:(*)
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  7. State:(*)
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  8. Zip Code:
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  9. Phone:(*)
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  10. Email Address(*)
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  11. Are you a citizen of the United State?(*)
    Please check yes or no.
  12. Date Available:(*)
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  13. If no, are you authorized to work in the U.S.?
    Please answer yes or no.
  14. Have you ever worked for this company?(*)
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  15. If yes, when?
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  16. Have you ever been convicted of a felony?(*)
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  17. If yes, explain:
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  1. Education

  2. High School:
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  3. Address:
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  4. From:
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  5. To:
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  6. Did you graduate?
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  7. _______________________________________________
  8. College:
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  9. Address:
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  10. From:
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  11. To:
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  12. Did you graduate?(*)
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  13. _______________________________________________
  14. Other:
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  15. Address:
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  16. From:
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  17. To:
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  18. Did you graduate?
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  19. Degree:
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  20. Degree:
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  1. References

  2. Please list three professional references.
  3. Full Name:
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  4. Relationship:
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  5. Company:
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  6. Phone:
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  7. Address:
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  8. _______________________________________________
  9. Full Name:
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  10. Relationship:
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  11. Company:
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  12. Phone:
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  13. Address:
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  14. _______________________________________________
  15. Full Name:
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  16. Relationship:
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  17. Company:
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  18. Phone:
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  19. Address:
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  1. Previous Employment

  2. Company:
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  3. Phone:
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  4. Address:
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  5. Supervisor:
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  6. Job Title:
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  7. Starting Salary: $
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  8. Ending Salary: $
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  9. Responsibilities:
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  10. Employed From:
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  11. To:
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  12. Reason for Leaving:
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  13. May we contact your previous supervisor for a reference?
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  14. _______________________________________________
  15. Company:
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  16. Phone:
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  17. Address:
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  18. Supervisor:
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  19. Job Title:
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  20. Starting Salary: $
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  21. Ending Salary: $
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  22. Responsibilities:
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  23. Employed From:
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  24. To:
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  25. Reason for Leaving:
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  26. May we contact your previous supervisor for a reference?
    Please answer yes or no.
  27. _______________________________________________
  28. Company:
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  29. Phone:
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  30. Address:
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  31. Supervisor:
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  32. Job Title:
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  33. Starting Salary: $
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  34. Ending Salary: $
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  35. Responsibilities:
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  36. Employed From:
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  37. To:
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  38. Reasoon for Leaving:
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  39. May we contact your previous supervisor for a reference?
    Please answer yes or no.
  1. Military Service

  2. Branch:
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  3. Enlisted Date:
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  4. Discharged Date:
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  5. Rank at Discharge:
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  6. Type of Discharge:
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  7. If other than honorable, explain:
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  8. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
  9. Employment Agreement(*)
    You must choose one item
  10. Your Signature(*)
    Please type you full name here
  11. Date:
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  12. Security
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Useful Links

Visit Us

1605 NE 99th Street

Vancouver, WA 98665

phone: 360-571-5226

fax: 360-450-4865

Our Hours

Monday - Friday 8:00 am to 5:00 pm

Saturday: Closed

Sunday: Closed