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The form requests work authorization in the U.S., prior company employment history, and disclosures related to Medicare fraud convictions with explanation when applicable. It gathers education history, professional licenses or certifications, previous employment information and references, plus military service details. A disclaimer and signature section certifies accuracy, consent to background checks and physical examinations, and at-will employment terms.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":16,"@type":70,"position":76},"https://docshare.wps.com/template/resumes/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/aal-employment-application-2022/194881/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/aal-employment-application-2022/194881.png","ImageObject",442,249,{"name":88,"@type":89},"Melati","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-27","2026-09-03",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is required for applicant contact and application details?","Question",{"text":109,"@type":110},"The form collects full name, address, phone number, email address, position applied for, and desired employment date and status.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What work authorization and disclosure questions must applicants answer?",{"text":114,"@type":110},"Applicants indicate whether they are authorized to work in the U.S., whether they previously worked for the company, and whether they have been convicted of Medicare fraud, including an explanation if yes.",{"name":116,"@type":107,"acceptedAnswer":117},"What do the disclaimer and signature certify?",{"text":118,"@type":110},"Applicants certify answers are true and complete, consent to investigations of past employment and activities, agree to cooperate in investigations, and acknowledge at-will employment and potential drug testing and physical examinations.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},194881,1788443528,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":15,"category_name":16,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":9},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","| Full Name: |  |  |  | Date: |  |\n| --- | --- | --- | --- | --- | --- |\n\n\n| Address: |  |  |\n| --- | --- | --- |\n\n\n|  |  |  |\n| --- | --- | --- |\n\n\n| Phone: |  |  |  |  | E-mail Address: |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Date Available: |  |  |  | Social Security No.: |  |  | Desired Salary: | $ |\n| Position Applied for: |  |  |  |  |  |  |  |  |\n\n\n| Are you authorized to work in the U. S.?  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Have you ever worked for this company? | YES\u003Cbr>|  | NO\u003Cbr>|  |  | If yes, when? |  |\n| Have you ever been convicted of Medicare fraud? | YES\u003Cbr>|  | NO\u003Cbr>|  |  | If yes, explain: |  |\n\n\n| Times  Days\u003Cbr>Desired Employment Status |  | Evenings\u003Cbr>Full Time | | Overnights |  All  Part Time |\n| --- | --- | --- | --- | --- | --- |\n| How did you find out about this job opening? |  |  |  |  |  |\n|  Web Page (identify) |  Newspaper/ Journal Ad (identify) |  |  |  |  |\n|  Referral  Job Service  Other (please explain) |  |  |  |  |  |\n\n\n| Education |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| High School: |  |  |  |  |  | Address: |  |  |  |  |\n| From: |  |  | To: |  | Did you graduate? |  | YES\u003Cbr>| NO\u003Cbr>| Degree: |  |\n| College: |  |  |  |  |  | Address: |  |  |  |  |\n| From: |  |  | To: |  | Did you graduate? |  | YES\u003Cbr>| NO\u003Cbr>| Degree: |  |\n| Other: |  |  |  |  |  | Address: |  |  |  |  |\n| From: |  |  | To: |  | Did you graduate? |  | YES\u003Cbr>| NO\u003Cbr>| Degree: |  |\n\n\n| Professional Licenses and/or Certifications |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Type | Origin or State Issued | Date Issued | Number | Verification\u003Cbr>(office use only) |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n\n\n| Previous Employment |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Company: |  |  |  |  |  |  |  |  | Phone: |  |  |  |\n| Address: |  |  |  |  |  |  |  |  | Supervisor: |  |  |  |\n| Job Title: |  |  |  |  |  |  | Reason for Leaving: |  |  |  |  |  |\n| Responsibilities: |  |  |  |  |  |  |  |  |  |  |  |  |\n| From: |  |  |  | To: |  | May we contact your previous supervisor for a reference? |  |  |  |  | YES\u003Cbr>| NO\u003Cbr>|\n\n\n| Company: |  |  |  |  |  |  |  |  | Phone: |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Address: |  |  |  |  |  |  |  |  | Supervisor: |  |  |  |\n| Job Title: |  |  |  |  |  |  | Reason for Leaving: |  |  |  |  |  |\n| Responsibilities: |  |  |  |  |  |  |  |  |  |  |  |  |\n| From: |  |  |  | To: |  | May we contact your previous supervisor for a reference? |  |  |  |  | YES\u003Cbr>| NO\u003Cbr>|\n\n\n| Company: |  |  |  |  |  |  |  |  | Phone: |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Address: |  |  |  |  |  |  |  |  | Supervisor: |  |  |  |\n| Job Title: |  |  |  |  |  |  | Reason for Leaving: |  |  |  |  |  |\n| Responsibilities: |  |  |  |  |  |  |  |  |  |  |  |  |\n| From: |  |  |  | To: |  | May we contact your previous supervisor for a reference? |  |  |  |  | YES\u003Cbr>| NO\u003Cbr>|\n\n\n| Last | First | M.I. |\n| --- | --- | --- |\n\n\n| References |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| Please list three professional references and one personal reference. |  |  |  |  |  |\n| Full Name: |  |  | Relationship: |  |  |\n| Company: |  |  |  |  | Phone: |\n| Address: |  |  |  |  |  |\n\n\n| Full Name: |  |  | Relationship: |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| Company: |  |  |  |  | Phone: |  |\n| Address: |  |  |  |  |  |  |\n\n\n| Full Name: |  | Relationship: |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| Company: |  |  |  | Phone: |  |\n| Address: |  |  |  |  |  |\n\n\n| Full Name: |  |  | Relationship: |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| Company: |  |  |  |  | Phone: |  |\n| Address: |  |  |  |  |  |  |\n\n\n| Military Service |  |  |  |  |  |  |  |  |\n| --- | --- | ","cbCaifBLzFaIKe82","https://ap.wps.com/l/cbCaifBLzFaIKe82","pdf",203398,"English","# Applicant Information\n## Contact Details and Position\n## Work Authorization and Disclosures\n# Employment Preferences\n# Education and Credentials\n## Education Background\n## Licenses and Certifications\n# Previous Employment\n# References\n# Military Service\n# Disclaimer and Signature","[{\"question\":\"What information is required for applicant contact and application details?\",\"answer\":\"The form collects full name, address, phone number, email address, position applied for, and desired employment date and status.\"},{\"question\":\"What work authorization and disclosure questions must applicants answer?\",\"answer\":\"Applicants indicate whether they are authorized to work in the U.S., whether they previously worked for the company, and whether they have been convicted of Medicare fraud, including an explanation if yes.\"},{\"question\":\"What do the disclaimer and signature certify?\",\"answer\":\"Applicants certify answers are true and complete, consent to investigations of past employment and activities, agree to cooperate in investigations, and acknowledge at-will employment and potential drug testing and physical examinations.\"}]","AAL Employment Application 2022 | PDF"]