Apply Step 1 of 7 14% PERSONAL INFORMATIONDateName LastName FirstName MiddleStreetCityStateZipPhone NumberSocial Security NumberRelatives employed by AM Haire?Referred By (If Applicable)How did you hear of us?(Required)Are you a US citizen or can provide documentation authorizing you to work in the US? No Yes Are you 18 years or older? Yes No BirthdateSingle Yes Married Yes Have you ever been convicted of a Felony? Yes No If yes please describe in details EMPLOYMENT DESIREDPositionDate You Can StartSalary DesiredAre you currently employed?if so may we contact your employer?Have you ever applied to this company before?Where?When?Resume uploadMax. file size: 100 MB. PREVIOUS EMPLOYERS (LIST YOUR LAST THREE EMPLOYERS BEGINNING WITH MOST RECENT)Employer Name & Address 1Phone Number 1Your Position & Duties 1Dates of Employment 1Salary 1Supervisor's Name 1Reason for Leaving 1Employer Name & Address 2Phone Number 2Your Position & Duties 2Dates of Employment 2Salary 2Supervisor's Name 2Reason for Leaving 2Employer Name & Address 3Phone Number 3Your Position & Duties 3Dates of Employment 3Salary 3Supervisor's Name 3Reason for Leaving 3 EDUCATIONHigh School Name & locationDate You Graduated 1Course Of Study 1College Name & LocationDate You Graduated 2Course Of Study 2Trade/Business School Name & LocationDate You Graduated 3Course Of Study 3Subjects of Special Study or Research WorkUS Military or Naval ServiceRankWhen?Present Membership in National Guard or Reserves PERSONAL REFERENCESPersonal Reference NamePersonal Reference AddressPersonal Reference PhonePersonal Reference Name 2Personal Reference Address 2Personal Reference Phone 2Personal Reference Name 3Personal Reference Address 3Personal Reference Phone 3 PHYSICAL RECORDDo you have any physical limitations that prevent you from performing any work for which you are being considered? Yes No If yes what can be done to accommodate your limitation? EMERGENCY CONTACTEmergency Contact NameEmergency Contact RelationEmergency Contact Phone**I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. Yes I AUTHORIZE INVESTIGATIONS OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU. Yes I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINATE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE** Yes DATE
