Liggettville Employment Application (Non-Exempt)

Today's Application Date*

In what location are you applying for a Position?*

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Applicant Information

First Name*

Middle Name

Last Name*

Contact Information

Mobile Number*

Email Address

Preferred Method of Contact*

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Work Eligibility

Are you 17 years or older?*

Required for work eligibility in some states

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Are you legally eligible to work in the United States?*

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Work History

Current/Most Recent Employer #1*

Company Name

Job Title #1

Emloyed Dates (Job #1)

Enter Start Date and End Date example: 10/01/2018 - 2/4/2019

Why did you leave?

Type N/A if still employed

Previous Employer #2

Job Title #2

Employed Dates (Job #2)

Enter Start Date and End Date example: 10/01/2018 - 2/4/2019

Why Did You Leave #2?

Availability

Date available to start work?

Days of the Week Available for Work*

Select All That Apply

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Hours of Availability*

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Are you able to commute to this location?*

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By checking this box, I certify that all information provided is true and correct to the best of my knowledge. I agree and understand that any falsifications, omissions, or misrepresentations will result in ineligibility for employment.

Acknowledgment*

Send me a copy of my responses

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