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Programs, services, and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.
Applicant Data
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| * Required Field |
| *First Name |
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| Middle Name |
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| *Last Name |
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| *Address |
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| Address 2 |
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| *City |
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| *State |
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| *ZIP Code |
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| Phone |
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| Cell Phone |
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| Email |
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| *Position |
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| How were you referred? |
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*If you are under 18 years of age, can you provide a work permit?
Yes
No
N/A
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*Have you ever worked for this company?
Yes
No
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If yes, when?
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*Are you a U.S. citizen?
Yes
No
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*Are you legally eligible to work in the U.S.?
Yes
No
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*Type of employment desired
Full-time
Part-time
Temporary
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*I am interested in and available to work the following shifts (check all that apply)
6:30 am 2:30 pm
2:30 pm 10:30 pm
10:30 pm 6:30 am
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*Have you ever pleaded guilty, no contest, or been convicted of a crime?
Yes
No
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If yes, give dates and details
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| Answering yes to these questions does not constitute an automatic rejection of employment. Date of the offense,
seriousness, and nature of the violation, rehabilitation, and position applied for will be considered. The applicant has an obligation to advise Five Star Living of any conviction of any crime that relates to the physical harm of any persons or financial fraud or theft to any person or business. Failure to do so is grounds for immediate termination. |
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Driver's License
Number(if applicable) |
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| Driver's License State |
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