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FreedomPark Employment Application
Tell us about yourself.
Full Name:
Street Address:
Appartment Number:
City:		State:		Zip:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Are you legally qualified to work in the US?
Are you 21 years old or older?
What position are you applying for?

Tell us about your education.
High School
Name of School:
City and State of School:
Number of Years Attended:
Did you graduate?

College or Other Education
Name of School:
City and State of School:
Number of Years Attended:
Did you graduate?
Degree:

Tell us about the most recent jobs you have held.
Current or Most Recent Job
Job Title:
Employer:
City and State:
Month and year you started?
Month and year you ended?
Supervisor:
Phone Number:
Reason for Leaving:

Prior Job
Job Title:
Employer:
City and State:
Month and year you started?
Month and year you ended?
Supervisor:
Phone Number:
Reason for Leaving:

Prior Job
Job Title:
Employer:
City and State:
Month and year you started?
Month and year you ended?
Supervisor:
Phone Number:
Reason for Leaving:

Prior Job
Job Title:
Employer:
City and State:
Month and year you started?
Month and year you ended?
Supervisor:
Phone Number:
Reason for Leaving:

Tell us about your driving record.
Our insurance policy excludes anyone with more than two moving violations on their driving record for the past 3 years. If you are applying for a position that will require you to drive, please list here all moving violations in the past 3 years
	Violation	Month	Year




Our insurance policy also excludes anyone with more than one at-fault accident in the past 3 years. If you are applying for a position that will require you to drive, please list here all at-fault accidents in the past three years.
	Description	Month	Year



Have you ever been convicted of a DWI?

Whom can we call for more information about you?
Please list 2 people who have observed you on the job and whom we can contact for a reference
	Reference Name	Phone Number



Please list one person who knows you personally and whom we can contact for a reference.
	Reference Name	Phone Number


Describe your employment goals and your current career circumstances (example: "student looking for part-time evenings" or "recently laid off looking for full-time day shift work", etc.)


By clicking the SUBMIT button I affirm that my answers are true and complete. I understand that if I am hired, any false or incomplete statements on this application will be grounds for immediate discharge.