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Fanshack.com Employment Application

Contact Information
Enter Name:
Home Address:		City:
		State/Zip:
Home Phone:		Email:
Cell Phone:

Employment Authorization
Desired Wage:
Dates Available to Work:
For Which Position are you Applying:
Days Available:	S: M: T: W: T: F: S:
What Hours?
Are there Any hours you can't work?
Do you prefer to work:	Full-time: Part-time: Temporary:
Have you ever worked for this company?	YES: NO:
If yes give name used when you worked and location:
Relatives working for this company:
Are you a US citizen?	YES: NO:
If NO, do you possess any of the required documents which permits you to work here?	YES: NO:
If YES, describe the document or documents (a copy of these documents will be required at interview):
If you are offered a job, are you willing to take a post-offer medical examination as permitted by the ADA?	YES: NO:
If known by other names at other employers listed under Employment History, please list:

Certification or other Registrations
If applying for positions that requires a drivers license, certification or other registration please list below:
Type:		No.:
Type:		No.:

Employment History
Account for the last five years' employment, beginning with the most recent job. All time must be account for. Complete all the information as to each employer in the spaces provided below:

Job I.
Name of Company:
Address of Company:
Phone:
Type of Business:
Supervisor:
Date Employed (From/To):
Position/Title:
Salary:
Reason for Leaving:
Brief Description of Duties (Max 100 Characters):

Job II.
Name of Company:
Address of Company:
Phone:
Type of Business:
Supervisor:
Date Employed (From/To):
Position/Title:
Salary:
Reason for Leaving:
Brief Description of Duties (Max 100 Characters):

Job III.
Name of Company:
Address of Company:
Phone:
Type of Business:
Supervisor:
Date Employed (From/To):
Position/Title:
Salary:
Reason for Leaving:
Brief Description of Duties (Max 100 Characters):

Prior Terminations
If applying for positions that requires a drivers license, certification or other registration please list below:
Have you every been discharged or forced to resign for misconduct or unsatisfactory performance?	YES: NO:
If yes, give details, including the name and address and/or telephone number of the employer who terminated your employment and the reason you were told you were terminated:

Do you agree that the reason given for your termination was valid?	YES: NO:

Education
Education or training which you believe qualifies you for the position you are seeking.
High School
Name & Location:	From/To Month/Year
	Course of Study	Graduated?
	Specific Degree
Trade/Technical School:
Name & Location:	From/To Month/Year:
	Course of Study	Graduated?
	Specific Degree
College
Name & Location:	From/To Month/Year:
	Course of Study	Graduated?
	Specific Degree
Military:
Name & Location:	From/To Month/Year:
	Course of Study	Graduated?
	Specific Degree
Other:
Name & Location:	From/To Month/Year:
	Course of Study	Graduated?
	Specific Degree

Miscellaneous Information

Have you every been convicted of any crime (other than minor traffic violations unless applying for a driving position) within the last five years?	YES: NO:
If you answer is "YES", explain details and indicate when, where and disposition of each case. (A conviction will not bar you from employment unless it is job-related.)

Other than answered elsewhere in this application, do you have knowledge of any facts which you believe are relevant to your qualifications to perform the job for which you are applying? List all special skills, experience or training you consider relevant to the position you seek.

Do you speak or read any language other than English? If so, please identify and describe your proficiency level.

To the best of your knowledge, has anyone ever filed a complaint in federal or state court, or a charge with any local, state, or federal agency, against you alleging unlawful harassment or unlawful discrimination. Has anyone accused you of harassing them or discriminating against them? If so, please give dates, employer, circumstances and outcome. (An affirmative answer does not constitute an automatic bar to employment.)

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