Application For Employment Landmark Application for Employment Landmark Application for Employment Position(s) Applied For * How Did You Learn About Us? Advertisement Employment Agency Relative Friend Inquiry Other Last Name * First Name * Middle Name * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone Number * Email address * Best time to contact you at home is: * 121234567891011 : 0030 AMPM If you are under 18 years of age, can you provide required proof of your eligibility? * Yes No Have you ever filed an application with us before? * Yes No If Yes, give date Have you ever been employed with us before? Yes No If Yes, give date Do any of your friends or relatives, other than spouse, work here? * Yes No Are you currently employed * Yes No May we contact your present employer? Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? * Yes No Do you understand that Proof of citizenship or immigration status will be required upon employment? * Yes No Date available for work * What is your desired salary range? Are you available to work * Full Time Part Time Temporary Are you currently on “lay-off” status and subject to recall? Yes No Can you travel if the job requires it? * Yes No Please Attach Resume or Fill Out Information Below Drop a file here or click to upload Choose File Maximum upload size: 5MB Education Elementary School Name/Address of School/Course of Study/Number of Years Completed/Diploma or Degree High School Name/Address of School/Course of Study/Number of Years Completed/Diploma or Degree Undergraduate College Name/Address of School/Course of Study/Number of Years Completed/Diploma or Degree Graduate College or Professional School Name/Address of School/Course of Study/Number of Years Completed/Diploma or Degree Other (Specify) Name/Address of School/Course of Study/Number of Years Completed/Diploma or Degree Describe any Specialized training, apprenticeship, skills and extra-curricular activities. Describe any job related training received in the United States Military. Section Start with your present or last job. Include an job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status Employer 1 Dates Employed Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Work Performed Phone Number Job Title Supervisor Reason for Leaving Employer 2 Dates Employed Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Work Performed Phone Number Job Title Supervisor Reason for Leaving Employer 3 Dates Employed Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Work Performed Phone Number Job Title Supervisor Reason for Leaving Employer 3 Dates Employed Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Work Performed Phone Number Job Title Supervisor Reason for Leaving Employer 4 Dates Employed Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Work Performed Phone Number Job Title Supervisor Reason for Leaving If you need additional space, please enter it here List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status. Other Qualifications-Summarize special job-related skills and qualifications acquired from employment or other experience. Specialized Skills (Check Skills/Equipment Operated) Terminal PC/MAC TypewriterTypewriter SpreadsheetSpreadsheet Word ProcessingWord Processing ShorthandShorthand Please List Production/Mobile/Machinery/Other Operated State any other additional information you feel may be helpful to us in considering your application. Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation? 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