b'Legally Gather RelevantInformation from Job CandidatesEmployment History Employment History ComplyRightStarting with your most recent employer, provide the following information. You may include any verified work performed on a volunteer basis. Starting with your most recent employer, provide the following information. You may include any verified work performed on a volunteer basis. BestEmployerTelephone # EmployerTelephone # State-Specific ApplicationStreet address() StateStreet address() StateCalifornia SellerStarting job title/final job titleYour Company Name CityMonthYear MonthYear Starting job title/final job titleCityMonthYear MonthYear for Employment Application for Employment Your Company NameDates employedDates employed Application for Employment Immediate supervisor and title (for most r Street Address May we contact for reference?/to / Immediate supervisor and title (for most recent position held)May we contact for reference?/to / Please Print Street AddressWhy did you leave? ecent positiStat Why did you leave? E-mail: Gather the job-related information you need withoutEqual acce f s o s t t o p i r i ograms, se t r a v l r ic i e e s an l i d e t mp it e loy i i m e i e e l nt op t p i x i o p r r tun s ities is av l it a l il ie r a n b t l r e to a r ll p d er t s i a ons w e d it i h t o y u l t r l e Cit i l c y, Statea l ZIP l l o t l r o e r, disa c bilit r y, aw.Please Print City, on held)e ZIP Yes No Later E-mail: Yes No LaterSummarize the type of work performed and job responsibilities. Summarize the type of work performed and job responsibilities. crossing into illegal territory. These specific applicationsr g a e c netic in ld c r r ma r t t ion, gend r er, gende s r id e ent a y, g t a nder e t uc esion, mar xt al s t atus, me ec ic v l c t o h n irs tio s n, m gar t d t t o age, an r ce c st u r t y, c s, national oigin, il e (in t cues t s u a f ts his t t e o r e ic ic ly as e s o t cia es ed w r l th race, s r io it h as ha x ir te b l r u s e and p le ot r an a m e ha r ba p e ic le r il e t ar e y or vete l d an s o at t u a e a gnany,o l cal l s Equal access to programs, services and employment opportunities is available to all persons without regard to sex (including pregnancy,f chdbir r h, b l ea io t a eeding, an e d/or r at c d m c b d il ic iz u l con o d f m n e s), se p ual o if e st atio s n, o p o t c t y o i aws, ap c s), r o r ig il io l n, sex (in r r so t des p e, and/or l c tionsexual orientation and gender identity), race, color, religion, national origin, citizenship, age, disability, genetic information, or any otherWhat did you like most about your position?What did you like most about your position? In accodane w h the Am pl r e a ans w r h Dis s sho v s Act and/or ap ica ou ate and l ar l l nt. Ex is p t e e ed by fe e e cc , s b o ccommoda ude basis protected by federal, state, and/or local law.What were the things you liked least about the position? What were the things you liked least about the position? are available for every state and the District of Columbia,or the appica n and/or in v w proces o d n g w y the Human Re ces De e amp ans rquiring ra naIn accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonablemaking a change to the ap pr ic t tion p in o s; p idin quip te n n materias in an atrnae format suh a s of rasonabe a mmdations inaccommodations for the application and/or interview process should notify the Human Resources Department. Examples of reasonableTelephone # EmployerTelephone # using a sign lang ge in er; u g speia ed e t; or mod ying teting condtions. s ba e, large pin, or audio recording; Employer accommodations include making a change to the application process; providing written materials in an alternate format such as braille,() StateStreet address() Stateand are carefully worded to include the correct language large print or audio recording; using a sign language interpreter; using specialized equipment; or modifying testing conditions. CityCity Street address Starting job title/final job titleDates employedMonthYear MonthYear Starting job title/final job titleDates employed MonthY ear MonthYear and proper legal disclosures.Sim on/to / Immediate supervisor and title (for most recent position held)May we contact for reference?/to / Name __________________________________________________________________ Applicant ID #AddressLastDeborahStreetFirstMiddle A2451733 Main StreetHollywoodFL 33345LastFirstImmediate supervisor and title (for most recent position h pp Yes No Later E-mail: __________________________________________________________________________________________________Name __________________________________________________________________A eld)licant ID # _____________________ May we contact for reference?E-mail: Yes No LaterMiddle () City_____________________Why did you leave? Why did you leave? Telephone # _________________Cellular/Other Phone # ________________ E-mail Address ____________________________Address __________________________________________________________________________________________________954 554-1234Telephone # _________________Cellular/Other Phone ()E-mail Addre . ss ____________________________ Summarize the type of work performed and job responsibilities. Complies with the June 2020 U.S. Supreme CourtSim StateZIP CodeStreetCityStateZIP Code() Summarize the type of work performed and job responsibilities () # ________________ Position(s) applied for _____________________________________________________ Date of application __________________Referral S Marketingon@ aol.comWhat did you like most about your position? / /Position(s) applied for _____________________________________________________ Date of application __________________ What did you like most about your position?Referral Source(e.g., Walk-in, Job Posting, Companys Website, etc.)_________________________________________________________ What were the things you liked least about the position? decision on LGBTQ discrimination in the workplace ource(e.g., Walk-in, Job Posting, Companys Website, etc.) 3 14 2021What were the things you liked least about the position? / /If necessary, b_________________________________________________________EmployerTelephone #: PMest time to call you is ______________ : Will you reloEmployerAMWill you travel if job requires it? Yes No Telephone # ()If necessary, best time to call you is ______________ Other than time off for reasons related to your religion, a disability,() StateStreet addressCityStateAsks probing job-related questions including skills, HomeCellular/Other Street addressCity HomeCellular/Other 2 00AMYes No Yes No or a medical condition, are there any days or times when you areDates employedMonthYear MonthYear Starting job title/final job titleDates employedMonthY ear MonthYearPM cate if job requires it? . May we contact you at work? .Starting job title/final job titleble to work?___________________________________ /to / Immediate supervisor and title (for most recent position held)May we contact for reference?/to / employment history and reasons for leaving, and also unavaila May we contact you at work? . No Will you travel if job requires it? If yes, work number and best time to call: AM ____________________________________________________ May we contact for reference?E-mail: E-mail: If yes, work number and best time to call:Yes AM Other than time off for reasons related to your religion, a disability,______________________________________________ Will you work overtime if required? . details gaps in historyYes No( ) : PM d title (for most recent position held) Yes No Yes No Later Why did you leave? Yes No LaterImmediate supervisor an( ) :PM or a medical condition, are there any days or times when you are______________________________________________ unavailable to work?If you are under 18 and it is required,Why did you leave? If no, please explain:_______________________________ If you are under 18 and it is required, can you furnish a work permit? N/A Yes No________________________________________________ Summarize the type of work performed and job responsibilities.If no, please explain:_______________________________ Are you able to perform the essential functions of the job for whichWhat did you like most about your position? Complies with all federal and state laws can you furnish a work permit? N/AYes No ____________________________________________________Summarize the type of work performed and job responsibilities. Have you submitted an application here before? Yes No you are applying (with or without reasonable accommodation)?What were the things you liked least about the position? If no, please explain:________________________________ ____________________________________________________What did you like most about your position?T t esigned to elicit information about an applicant\'s disability. Yes No Will you work overtime if required? .Yes NoIf yes, give date(s) and position(s):____________________ Phleisa sqeu deos inoontipsr onvoitd deh einthfoerrm acatcioomnm aobdouatti othne i se xniestceensscaer yo.fTah edsisea ibsiliuteys,pmaartyi cbuel arTelephone # EmployerTelephone #What were the things you liked least about the position? Have you submitted an application here before? ________________________________________________ accdormessed at a later stage to the extent permitted by law. s () StateStreet address() StateIncludes disclosures protecting employer from liabilitymodation or w If yes, give date(s) and position(s):If no, please explain:_________________________________Employerad _____________________ ____________________________________________________ eet adress________________________________________________Have you ever been employed here before? .Yes StrN d oYes No Need more information about the CityCity From ____________ To ______________ al job title jobs essential functions to respondto Have you ever been employed here bYes No Are you able to perform the essential functions of the job for which If yes, give dates:/ / / / Drivers license number required if driving may be required in theDates employedMonthYear MonthYear Starting job title/final job titleDates employedMonthY ear MonthYear Authorizes employment referencesStarting job title/finto / Immediate supervisor and title (for most recent position held)May we contact for reference?/ E-mail: / efore? .you are applying (with or without reasonable accommodation)?Is this application a request for reemployment following an extendedjob for which you are applying: / If yes, give dates: From ____________ To/ / This question is not designed to elicit information about an applicant\'s disability. Please Immediate supervisor and title (for most recent position held)May we contact for reference?E-mail:military leave of absence from this company? .Yes No ____________________________________State __________ Yes No Later Why did you leave? Yes No LaterIf yes, additional information may be requested. Why did you leave?Yes No Includes a ComplyRight guide to help you / / ______________ do not provide information about the existence of a disability, particular accommodation, Have you ever been bonded? .Is this application a request for reemployment or whether accommodation is necessary. These issues may be addressed at a later stage Are you lawfully authorized to work Summarize th Have you entered into an agreement with any former employer orSummarize the type of work performed and job responsibilities. to the extent permitted by law.in the United States? Yes No other party (such as a noncompetition agreement) that might, in anyWhat did you like most about your position? screen and interview candidates the right way f following an extended military leave of absence Yes NoYesNoNeed more information about thee type of work performed and job responsibilities. rom this company? .What did you like m ay, restrict your ability to work for our company?. .If yes, additional information may be requested. Drivers license numb jobs essential functions to respond/ / w ost about your position?Yes NoDate available for work .______________What is your desired salary range or hourly rate of pay? What were the thin If yes, please explain: _______________________________ What were the things you liked least about the position? Are you lawfully authorized to work in er required if driving may be required in the gs you liked least about the position?$ _______________________Per _________________________________________________________________ Page 2 Page 2 DescriptionItem #Price the United States? Yes No job for which you are applying: ________________________________________________Date available for work ____________________________________Type of employment desired: Full-Time Part-Time NOTE TO RHODE ISLAND APPLICANTS: This company is subject to the states workers compensationEducational Co-Op Seasonal Temporary laws (Chapter 29-38) unless otherwise noted below (employer to list applicable exemptions): StandardLD1-A2179$69.95.______________ Have you ever been b State __________What is your desired salar / / onded? .Yes No____________________________________________________ $ y range or hourly rate of pay?Will you relocate if job requires it?Yes No ____________________________________________________ ComplyRight DownloadableLD1-A2179DL$42.95 Typ_______________________ Per _________________ Have you entered into an agreement with any former employer or e of employment desired: Full-Time Part-Time other party (such as a noncompetition agreement) that might, in any AN EQUAL OPPORTUNITY EMPLOYER Page 1 50-State Compliant Job Application PersonalizedLD1-A2179I$80.95 DownloadableEducational Co-Op Seasonal Temporary way, restrict your ability to work for our company? Yes NoIf yes, please explain:_______________________________Long Form; 4 pagesPrice per pkg/50. Size: 17" x 11".________________________________________________If you have businesses in more than one state, these applications arePersonalize up to 4 lines.AN EQUAL OPPORTUNITY EMPLOYERthe best to get the job-related information you need. Theyre attorneyPage 1Your Company Name developed and carefully worded to include the correct language andEmployment History Employment History(continued)Explain any gaps in your employment, other than those due to personal illness, injury, or disability. _____________________________Street Address Starting with your most recent employer, provide the following information. Application for Employment City, State ZIP proper legal disclosures required by all federal and state laws. EmployerTelephone # ____________________________________________________________________________________________________________Please Print Street addr ABC, Inc. 954555-1212 State____________________________________________________________________________________________________________() ess City 222 Stirling WayHollywoodFL33345Equal access to programs, services and employment opportunities is available to all persons without regard to sex (including pregnancy, sexualStarting job title/final job titleDates employedMonthYear MonthYear ____________________________________________________________________________________________________________orientation and gender identity), race, color, religion, national origin, citizenship, age, disability, genetic information, or any other basisContains mandatory disclosures for all 50 states Marketing3/ 01792017Yes Noprotected by federal, state, and/or local law.Immediate supervisor and title (for most recent position held)May we contact for reference? 2 to/ If not addressed on previous page, have you ever been fired or asked to resign from a job? . E-mail:In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodationsMs. Taylor Yes No Later If yes, please explain:_______________________________________________________________________________________for the application and/or interview process should notify the Human Resources Department. Examples of reasonable accommodations includeComplies with the June 2020 U.S. Supreme Court decision Why did you leave?________________________________________________________________________________________________________making a change to the application process; providing written materials in an alternate format such as braille, large print or audio recording;Location reasonsusing a sign language interpreter; using specialized equipment; or modifying testing conditions. Summarize the type of work performed and job responsibilities.on LGBTQ discrimination in the workplace What did you like most about your position?________________________________________________________________________________________________________Name _______________________________________________________________________________________________________ What were the things you liked least about the position?________________________________________________________________________________________________________LastFirstMiddleAddress _____________________________________________________________________________________________________ Excludes criminal questions in compliance with ban the box laws EmployerTelephone # Skills and QualificationsStreetCityStateZIP CodeE-mail address _________________________________________________________________ Phone () Street address() StateSummarize any special training, skills, languages, licenses, and/or certificates that may assist you in performing the position for which you are applying:________________________ City ____________________________________________________________________________________________________________Position applied for _ ____________________________________________________________Shift preferred123Any Excludes salary history questions in compliance with the salaryStarting job title/final job titleDates employed MonthYear MonthYear ____________________________________________________________________________________________________________Special training or skills (languages, machine operation, etc.) that would benefit you in the job for which you are applying: Immediate supervisor and title (for most recent position held)May we contact for reference?/to / ____________________________________________________________________________________________________________history ban and equal pay laws Yes No Later E-mail:___________________________________________________________________________________________________________________________ Why did you leave? Computer Skills(Include software titles and level of experience, such as basic, intermediate, or advanced.)___________________________________________________________________________________________________________________________Word Processing _________________________Level: _____ Internet ________________________________Level: ______ ___________________________________________________________________________________________________________________________ Includes a ComplyRight guide to help you screen and interviewSummarize the type of work performed and job responsibilities.Spreadsheet _____________________________Level: _____ Other __________________________________Level: ______ Would you accept full-time work?Yes NoWould you accept part-time work? YesNo candidates the right way What did you like most about your position?Presentation____________________________Level: _____ Other __________________________________Level: ______ On what date would you be available for work? ________________________________ What were the things you liked least about the position?E-mail _________________________________Level: _____ Other __________________________________Level: ______Have you ever been employed here?Yes NoIf yes, dates:_________________________________________________________ EmployerTelephone #Yes No () Educational BackgroundAre you lawfully authorized to work in the United States? If you are under 18 years old, can you furnish a work permit if required?N/A Yes No DescriptionItem #Price Street addressCityStateStarting with your most recent school attended, provide the following information.# of YearsGPAAre you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)?Starting job title/final job titleDates employedMonthYear MonthYear School (include City and State) Completed Completed Class Rank Major/MinorThis question is not designed to elicit information about an applicants disability. Please do not provide information about the existence of a disability,Short FormStandardLD1-A0374 $56.95 Immediate supervisor and title (for most recent position held)May we contact for reference?/to /Diploma GEDparticular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law. E-mail:______________________Certifi on __________________DegreecatiYesNoNeed more information about the jobs essential functions to respond.Yes No LaterOther________________________ Notice to Rhode Island applicants: This Company is subject to the states workers compensation laws (Chapters 29-38) unless otherwise noted below: Fill-and-Save LD1-A0374CFL$27.95 Why did you leave? GEDDiplomDegree a______________________ Certifi cation __________________ _____________________________________________________________________________________________________________________________________ Personalized LD1-A0374I$66.95 Summarize the type of work performed and job responsibilities. Other________________________(Employer to list applicable exemptions)Diploma GED What did you like most about your position? Degree Starting with your most recent school attended, provide the following information. # of YearsCompleted GPA Major/Minor Long FormStandardLD1-A0019 $69.95 What were the things you liked least about the position? Telephone # Statecati ComplyRight Job Educational Background Certifi ______________________ on __________________ Other________________________School (include City and State) Completed Class Rank EmployerDegreea______________________ Diplom GED Diploma GEDFill-and-Save LD1-A0019CFL$32.95 Street address()Applications comply Certification __________________ Degree ______________________ City Other________________________Certification __________________ Other________________________ Personalized LD1-A0019I $80.95 Starting job title/final job titleDates employedMonthY ear MonthYear ReferencesGEDImmediate supervisor and title (for most recent position held)May we contact for reference?/to / If not applicable, list three school or personal references who are not related to you. with the U.S. Supreme DiplomDegree a______________________ List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. Certification __________________ E-mail:Other________________________Degreecatia______________________ Price per pkg/50. Short form: 8" x 11". Long form: 17" x 11". Why did you leave? Yes No Later NameTitleRelationshipTelephone E-mail# of Ywnear sGEDPersonalize up to 4 lines.Summarize the type of work performed and job responsibilities.to You() Court decision on Diplom on __________________ KnoCertifi Other________________________Diplom GED Degree a______________________ cation __________________What did you like most about your position? () LGBTQ discriminationCertifiOther________________________Fill-and-Save item What were the things you liked least about the position? Page 2 Page 3 () in the workplace.Short Form; 2 pages14 WORKPLACE MANAGEMENTHIRING HRDIRECT.COM800.999.9111 15'