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Career Form

Career Form

Arsen Gurgov

Application For Employment

An Equal Opportunity Employer – All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, pregnancy, sexual orientation, marital status, alienage or citizenship status, creed, genetic predisposition or carrier status, unemployment status, credit history, gender identity, gender expression, or any other protected characteristic as established by law.

Personal Information

Incomplete information could disqualify you from further consideration. Please complete all fields.

Name *

Date *

Address *

E-mail Address *

Phone # *

Are you eligible to work in the U.S? *

Yes

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) *

Yes

Employment Desired

Position desired *

Date you can start *

Hourly Rate/Salary desired *

Are you currently employed? *

If so may we inquire of your present employer? *

Yes

Referral Source

How did you hear about us (please circle one)? Walk In Advertisement Referral Internet Other

Have you ever worked for this company before? *

Yes

Do you know anyone who works for our company? *

Yes

If yes, who? *

Employmeny History

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employer Name	Telephone	Address	Immediate Supervisor and Title

For each Employer provide:

Employer Name	From	To	Job Title	Summarize nature of work performed	Reason for leaving

Military

Have you served in the military? *

Yes

Education

Education	Name and location of school	No. of yrs. Attended	Degree Received	Subjects studied/Major
High School
College or University
Trade, Business or Correspondence School

References

Give the names of three persons not related to you, whom you have known at least three (3) years.

Name	Phone	Email Address	How do you know this person?	For how long have you known this person?

Supplemental Information

Are there any restrictions or limitations on the hours you can work? *

Yes

Are you available to work on weekends? *

Yes

Can you work overtime? *

Yes

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Arsen Gurgov to hire me. If I am hired, I understand that either Arsen Gurgov or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Arsen Gurgov has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Arsen Gurgov true and complete information on this application. No requested information has been concealed. I authorize Arsen Gurgov to contact references provided for employment reference checks. I understand that any offer of employment I may receive from Arsen Gurgov is contingent on my satisfactory completion of a background check. If any information I have provided is found to be untrue, or if I am found to have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Date *

Signature *