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Yes ☒ No ☐  \nAre you legally eligible for employment in the U.S.? Yes ☒ No ☐  \nIndicate your hours of availability in which you are willing to work:  \nAny ☒ Mon ☐ Tues ☐ Wed ☐ Thu ☐ Fri ☐ Sat ☐ Sun ☐ All Hours ☐ Day Shift (7AM – 3PM) ☒  \nAfternoons (3PM – 11PM) ☒ Nights (11PM – 7AM) ☐ Have you ever been convicted of a crime (felony or misdemeanor) other than a minor traffic violation? This information may be considered in hiring or job placement, but will not automatically disqualify you for employment. Yes ☐ No ☒  \nIf yes, please explain: N/A   \nAre you willing and able to: Work Overtime?  \nYes ☒ No ☐  \nWork during holidays?  \nYes ☐ No ☒  \nProvide a valid Driver’s License?  \nYes ☒ No ☐  \nIf Yes: Issuing State: Iowa  Type:  Driver’s   \nEndorsements:  N/A  When will you be available to begin work?  \n2 weeks after offer of employment  \nAre you a veteran? Yes ☐ No ☒  \nIf yes, please list duty/specialized training: N/A  \n___________________________________________  \n___________________________________________  \nEDUCATION A  \n\n|  | School Name\u003Cbr>& Location | Years\u003Cbr>Completed | Field of Study | Did You\u003Cbr>Graduate? | Degree/ Certificate/Diploma |\n| --- | --- | --- | --- | --- | --- |\n| High School | Cedar Rapids\u003Cbr>High School | 4 | General | Yes | High School\u003Cbr>Diploma |\n| College/University | Kirkwood\u003Cbr>Community College | 2 | Industrial Maintenance | Yes | A. A. S. Industrial Maintenance |\n| Additional | N/A | N/A | N/A | N/A | N/A |\n\nEMPLOYMENT HISTORY A  \nList your most recent employment first, followed by previous job experience(s) . Use a separate sheet of paper if needed.  \n\n| Employer Name & Address:\u003Cbr>XYZ Warehouse Co\u003Cbr>Cedar Rapids, IA | Job Title: Picker/Packer |  | Start Date:\u003Cbr>07/2008 | End Date:\u003Cbr>Present |\n| --- | --- | --- | --- | --- |\n|  | Duties:\u003Cbr>Drive forklift, locate items in warehouse, place orders on pallets for shipment. |  |  |  |\n|  |  |  | Reason for Leaving: N/A |  |\n| Telephone:\u003Cbr>555-987-6543 |  |  |  |  |\n|  | Pay: $10/hr | Supervisor: Mike Greene |  |  |\n\n\n| Employer Name & Address:\u003Cbr>Hy-Vee\u003Cbr>Omaha, NE | Job Title: Stocker (PT) |  | Start Date:\u003Cbr>05/2006 | End Date:\u003Cbr>07/2008 |\n| --- | --- | --- | --- | --- |\n|  | Duties:\u003Cbr>Placed items neatly on shelves, assisted customers, and straightened aisles. |  |  |  |\n|  |  |  | Reason for Leaving:\u003Cbr>Moved to Cedar Rapids |  |\n| Telephone:\u003Cbr>555-012-3456 |  |  |  |  |\n|  | Pay: $6/hr | Supervisor: Tom Jones |  |  |\n\n\n| Employer Name & Address:\u003Cbr>N/A | Job Title: N/A |  | Start Date:\u003Cbr>N/A | End Date:\u003Cbr>N/A |\n| --- | --- | --- | --- | --- |\n|  | Duties:\u003Cbr>N/A |  |  |  |\n|  |  |  | Reason for Leaving: N/A |  |\n| Telephone: N/A |  |  |  |  |\n|  | Pay: N/A | Supervisor: N/A |  |  |\n\nSKILLS & QUALIFICATIONS A  \nOther qualifications such as special skills, abilities, or honors that should be considered, including types of computers, software, and other equipment you are qualified to operate or repair:  \n Diagnostic and repair experience on engines, pneumatic tools, production machines, and motors.  Some knowledge of HVAC systems and basic electrical equipment. Forklift license.  \n\n| Professional licenses, certifications, or registrations:\u003Cbr>Certified Maintenance & Reliability Technician (CMRT), Society for Maintenance & Reliability Professionals |  |  |  |  |  | May |\n| --- | --- | --- | --- | --- | --- | --- |\n| REFERENC","cbCairFXqkW6HGpr","https://ap.wps.com/l/cbCairFXqkW6HGpr","pdf",225267,"English","# Position Sought\n# Candidate Information\n# Education\n# Employment History\n# Skills & Qualifications\n# References\n# Notice to Applicant","[{\"question\":\"What information does the form collect about the candidate?\",\"answer\":\"It collects the candidate’s name, address, phone, email, Social Security number, eligibility and age confirmations, availability hours, and disclosure items such as convictions and veteran status.\"},{\"question\":\"How are work hours and start date handled in the form?\",\"answer\":\"The form asks the candidate to indicate availability (e.g., any hours, day shift, afternoons, nights) and to specify when they will be available to begin work, such as “2 weeks after offer of employment.”\"},{\"question\":\"What sections must be completed for employment history and references?\",\"answer\":\"Employment history requires listing recent jobs with employer details, job title, start/end dates, duties, reason for leaving, pay, and supervisor. References require three professional contacts with names, contact information, occupation, and years known, along with applicant authorization and certification.\"}]","EMPLOYMENT APPLICATION - Position Sought | PDF",1789827186]