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Split Rock Parking, LLC
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Job Location
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Employment Application
Equal access to programs, services, and employment is available to all persons. Those applicants requiring
accommodation to the application and/or interview process should contact the department manager.
Applicant Information
Position(s) Applied For:
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Salary Desired $
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Referral Source
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Name
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First
Last
Social Security Number
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Date of Birth
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Email
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Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Drivers License Number and Expiration Date
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Are you legally eligible for employment in the U.S.?
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Yes
No
Have you been convicted of a felony?
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Yes
No
Type of employment desired:
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Full Time
Part TIme
Temporary
Seasonal
Educational Co-op
If you are under 18, can you furnish a work permit?
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Yes
No
Educational Data: High School, College, Graduate School, Trade, Business or Technical School
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Order to permit a check of your work and educational records, should we be made aware of any changes of name assumed name that you previously used?
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Yes
No
If Yes, identify names and relevant dates.
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Have you ever been dismissed or forced to resign from any employment?
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Yes
No
If Yes, please explain.
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Can you travel if job requires it?
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Yes
No
Are you able to meet the attendance requirements of the position?
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Yes
No
Will you work overtime if asked?
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Yes
No
Are there any hours, shifts or days you will not work?
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Yes
No
If Yes, explain.
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List any foreign language(s) you know and describe your skill level. (Speak Fluently, Read, Write)
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Do you have any friends or relatives who work here?
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Yes
No
If Yes, please List: Name, Relationship
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Character References: List three persons not related to you, whom you have known for at least one year. Include Name, Address, Telephone, and Occupation.
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List below any other information or remarks that you wish to have considered as a part of your application for employment.
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Have you filled an application here before?
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Yes
No
If Yes, Give date:
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Have you ever been employed here before?
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Yes
No
If Yes, Give date:
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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. (please type your full name)
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