b'Employment Applications Performance Management FormsCaliforniaApplication for Employment Employment History owing information.Telephone # StateEmployment History(continued) Employee Warning Notice Employee Warning Notice Please Print t h t i e c in r ce p f s p o s t l r t i m c o p t t t i s i r o o og a r g a n n m c p s n r , s t d e u r r i p c l l v r i t d r t i i c e g i c a v r t e ir t v e s a i t r i e n a a d e s c l r t r r e o mp c c s e e t s l c p s f o c l e e u i y s c e m i d h o e r e o l n i v u z t o i l ra a p i k t n p in o t u r i t f i r u s i t n t e o t i e n t r e l i i d a c e t e t a s i l u a s a t e e a v n s e r a s d i o e i l l c c a if a b s y d l t e t n r t c o a tit e i i l l s t t l p t i t e r e p e a r o a n s c c r t o t a o n m e s w u i r x c t t i a p i t s o h re n o x s s r u p s a i . t r i a c n li e t c g le a t e i r o d t t r r u i a o a t r il a g s e, a tt a r u n b s r c t l o e t s e e t r c e c ry, c t c i i t c s a i olo a r, d r s d t d t t i e i o i s i y c t o a l i t e b o e s), r il c it d y, r cl i l t u l i i i g o t i a n o ryStarting with your most recent employer, provide the fol Explain any gaps in your employment, other than those due to personal illness, injury, or disability. _____________________________gene e an sa a u n, r t e io o al o b e h h, b h d ds t g, a s h r r e r, g d r i l c e e o d w y, g n der e h as h e on, m x a al s n n a d p , m r b d a v l co ir o n n, m e n,Employer() ____________________________________________________________________________________________________________ Employee Warning NoticeE o f q o ual a e a c han a ge t n o th y, c p h p e o ew p e (in s s ia n m d no q g, g men n m y a n Re ia o t u a n e d n h r na e, s e x u n w m l o u p ir t s o n, o e e a on y o g h in o e h od u c a cmm d byin des r v , na in, r a in d/o d m os), s a r a s p Street addressCity____________________________________________________________________________________________________________ Please Print Please Print sex (includes preg n a r loca e l law. n p in oes; po ie e s Act and/or app r m lica ia b d le s in e a e d l g c l l o a a , a mp an s b ts requiring reasonable a o r n e o o a dg; / // /federal, state, and/o d/or in ; u g s isabilit ding w ip y the Hm o s in an a s D in e f d . E t s h a f r e, la e a mm r a s in Starting job title/final job titleDates employedMonthY ear MonthYear____________________________________________________________________________________________________________ Employee Name _________________________________________________________Date of Notice ____________________Employee Name _________________________________________________________Date of Notice ____________________Immediate supervisor and title (for most recent position held)May we contact f ence?/ E-mail: to / If not addressed on previous page, have you ever been fired or asked to resign from a job? .Yes No Employee/Payrol # ____________________ Department ____________________Date of Hire ______________________In accordance with the Americans with D e p , o Why did you leave? Yes Noor refer Later If yes, please explain:_______________________________________________________________________________________ Document employee violations and capture other important Employee/Payrol # ____________________ Department ____________________Date of Hire ______________________/ // /r t e a d e ; o g t n making a c ae inType of Violationusing a sign langu Summarize the type of work performed and job responsibilities.________________________________________________________________________________________________________ Type of Violation Willful Damage to Company PropertyOther:Name __________________________________________________________________ Applicant ID #_____________________ What did you like most about your position?________________________________________________________________________________________________________ information, including follow-up actions, employee statementsAttendanceWillful Damage to Company PropertyOther:Attendance LastFirstMiddle StateZIP Code What were the things you liked least about the position?________________________________________________________________________________________________________ Tardy/Early QuitViolation of Company Policies/ProceduresOther:Address__________________________________________________________________________________________________ Tardy/Early QuitViolation of Company Policies/ProceduresOther:Inappropriate BehaviorInsubordination Other:Streetular/Other Phone # ________________ Cityl Address ____________________________ EmployerTelephone # Skills and QualificationsInappropriate BehaviorInsubordination Other:() Cel ()E-mai ion __________________ Street address() StateSummarize any special training, skils, languages, licenses, and/or certificates that may assist you in performing the position for which you are applying: and possible consequences.Unsatisfactory PerformanceOther:Other:Telephone # _________________ ate of applicat / / Unsatisfactory PerformanceOther:Other:Position(s) applied for _____________________________________________________ D City____________________________________________________________________________________________________________(e.g., Walk-in, Job Posting, Companys Website, etc.) _________________________________________________________ Description of ViolationStarting job title/final job titleDates employedMonthY ear MonthYear ____________________________________________________________________________________________________________ Description of Violation Time __________________: AMReferral SourceImmediate supervisor and title (for most recent position held)May we contact for reference?/ to/ ____________________________________________________________________________________________________________ Date of Incident __________________Time __________________: PM/ / AM/ /E-mail: Date of Incident __________________PM: AM Wil l l you relocate if job requires it? .Yes No Why did you leave? Yes No Later Computer Skils (Include software titles and level of experience, such as basic, intermediate, or advanced.) Level: ______ Provides space to note relevant specifics: date, details Description:________________________________________________________________________________________________ Description:________________________________________________________________________________________________ PM ravel if job requires it? Yes No Summarize the type of work performed and job responsibilities.Word Processing _________________________Level: _____ Internet ________________________________ __________________________________________________________________________________________________________If necessary, best time to call you is ______________ Wil you t __________________________________________________________________________________________________________What did you like most about your position?Spreadsheet _____________________________Level: _____ Other __________________________________Level: ______Complies __________________________________________________________________________________________________________ HomeCelular/Other Yes No Other than time off for reasons related to your religion, a disability,__________________________________________________________________________________________________________May we contact you at work? . or a medical condition, are there any days or times when you areWhat were the things you liked least about the position?Presentation____________________________Level: _____ Other __________________________________Level: ______of incident, actions and consequences Employee StatementIf yes, work number and best time to call: : AM unavailable to work? Employee StatementEmployerTelephone #State E-mail _________________________________Level: _____ Other __________________________________Level: ______ with all I agree with employers statement.________________________________________________ ______________________________________________ ____________________________________________________( ) quired, No ____________________________________________________ l t I agree with employers statement.PMStreet address() Educational Background ended, provide the folowing information. I disagree with employers description of violation for these reasons: ________________________________________________I disagree with employers description of violation for these reasons: If you are under 18 and it is reN/A Yes Wil you work overime if required? . Yes Nocan you furnish a work permit? Starting job title/final job titleCityMonthY ear MonthYear Starting with your most recent school at # of YearsCompleted GPA Major/Minor3-part carbonless form provides copies for the employee, __________________________________________________________________________________________________________If no, please explain:________________________________ If no, please explain:_________________________________ Immediate supervisor and title (for most recent position held)Dates employedence?/ to/ School (include City and State) CompletedDiploma GEDClass Rank federal and ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Have you submitted an application here before? Yes No ____________________________________________________ Yes Noor refer Later Certifi on __________________ __________________________________________________________________________________________________________Why did you leave? May we contact fE-mail:Degreecati______________________ __________________________________________________________________________________________________________osition(s): _____________________ Are you able to perform the essential functions of the job for whichSummarize the type of work performed and job responsibilities. Other________________________ state laws.supervisor and recordkeepingActions to be Taken Probation Suspension Discharge Other:If yes, give date(s) and p you are applying (with or without reasonable accommodation)? Diplom GEDActions to be TakenDegreea ______________________ ________________________________________________ This question is not designed to elicit information about an applicant\'s disability. Pleasecation __________________ Warning Probation Suspension Discharge Other:Certifi Warning ver been employed here before? .Yes No do not provide information about the existence of a disability, particular accommodation,Other________________________Have you e or whether accommodation is necessary. These issues may be addressed at a later stage ______________________ Consequence should incident occur again: _______________________________________________________________________What did you like most about your position?Diploma GED Consequence should incident occur again: _______________________________________________________________________From ____________ To/ / to the extent permited by law.Need more information about the What were the things you liked least about the position? Degreecation ____________________________________________________________________________________________________________________________CertifiIf yes, give dates:/ / ______________ YesNoial functions to respond EmployerTelephone #Other________________________Includes a ComplyRight guide to help document __________________________________________________________________________________________________________Is this application a request for reemploymentjobs essentDiplom GED__________________________________________________________________________________________________________Degreecati a______________________ __________________________________________________________________________________________________________Certifi on __________________Street address() State Other__________________________________________________________________________________________________________________________________fol f owing an extended military leave of absenceYes NoDr j ivers license number required if driving may be required in the __________________________________________________________________________________________________________rom this company? . ob for which you are applying: Starting job title/final job titleCityMonthY ear MonthYear References violations and manage employee infractions the right way I have read and understand this Employee Warning Notice. _______________If yes, additional information may be requested. ____________________________________ State __________ Immediate supervisor and title (for most recent position held)Dates employedto/ List n I have read and understand this Employee Warning Notice. _______________Are you lawf t uly authorized to work in Yes No Have you ever been bonded? .Yes No May we contact for reference?/ E-mail: If not aamppes alicanbd tle, lielepst thhronee ne sumchoboerl os or pf terhrsoene bal rusineferesens/wces work rho aeferre ennces wot relhao atedr te on yootu r.elated to you and are not previous supervisors._________________________________________ _________________________________________ //_________________________________________ _________________________________________ //Employees Name (Print)Signature of Employee DateSignature of Employee Datehe United States? Why did you leave? Yes No Later Name TitleRelationshipTelephoneE-mail#Kno Employees Name (Print) _________________________________________ ________________________________________________________ Signature of Supervisor/Manager//Supervisor/Manager who issued warning (Print)Signature of Supervisor/Manager//to Youof Ywnear s _________________________________________ _________________________________________ _______________Supervisor/Manager who issued warning (Print)DateDate/ / Summarize the type of work performed and job responsibilities. __________________________________________________________________________________Date available for work . ______________ Have you entered into an agreement with any former employer or __________________________________________________________________________________What is your desired salary range or hourly rate of p ay? other party (such as a noncompetition agreement) that might, in anyRoutingWhat did you like most about your position? () ) A21913-Part CarbonlessRouting_____________________________________________________________________________________________________$ _______________________ Per_________________ way, restrict your ability to work for our company? .YesNo (_______________ ______________________________________________________________________________________ Full-Time Part-Time If yes, please explain:_______________________________ What were the things you liked least about the position? _______________ _____________________________________________________________________________________________________ ______________________________________________________________________________________Type of employment desired: Temporary________________________________________________ Page 2 Page 3 () A2191Standard Carbonless _______________ TT o ______________________________________________________________________________________ u ss pp o p_______________ ______________________________________________________________________________________ Educational Co-Op Seasonal AN EQUAL OPPORTUNITY EMPLOYER Page 1 t is designoevdid teod p rwt.i tYho tuh ae rue nudreged to consult a ative infoornm oatri ecer However, it insncirot at insugb, uation ainngd anydvice tainndg tehstisions or concer al olep fionri oannsy o dna manayg sesp eacriifsiicn fga cotustoorfstehrev iucsees .duct is deissi pgnroevdid teod p rwoivthid teh aec ucnudraetres atanndd ianugt htohraitt aatn ay tpoerrnsoeyncoor necnetrintyin ig your particular si tirtoudtue cfoinr gle oarn dy issptreicific q d does sp nroodt upcrot ivsi dnern le lgiaalb loe may have.Thhiesipnrfoortmy atoti ouns e this product. You are urged to consult an ive information. Hownvevolevre, ditiinsncroeta at isnugb,t uat udteu cfor l eogra ld aissptreibciufic qudoes p nroodt upcrot visid neons youfionri oannsy o dna manayg sesp eacriifsiicn fga cotustoorfstehrev iucsees .Thheis i pnrfoodrmucaoti ounse i st hpirs produc ovide acuratres taanndd ainugt htohraitt ann ayt tpoerrnsey con on nt. itnyin ing vyoolvuerd p iartcealar sit tirtoion andgal advibcue tainngu tehstiions or conc e t tle slgi ayobu may have.Price per pkg/50. Size: 8" x 11".22019221 ComplyRight, Inc. or ipnoarbtailnittyntote: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.Im r pinoarbtailni t note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.ImA 22109221 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111A Two easy ways to reorder: hrdirect.com800-999-9111State-Specific Application for EmploymentGather the job-related information you need without crossing into illegal territory. These specific applicationsare available for every state and the District of Columbia, and are carefully worded to include the correct language and proper legal disclosures. Each state-specific application includes the proper language and legal disclosures 7.General FactorsRatingScalePoints Supportive Details or CommentsCreativityThe extent to whics nh aewn O100-90em V 89-80 and bploetyteer wae proys oposes idef doinag ts, fhinindgs.necessary to keep you in compliance with your states requirements.Performance Appraisal G I79-70 69-60UBelow 60n em yeeO100-90PointsPlease Print 8.InitiativeThe extent to whicnd ah as ._____________________________________________Employee Name __________________________________________ seeks otiount nal dew auties wssighnmen nenets acessumesploV89-80 Asks probing job-related questions including skills, employment Department _____________________________________________ addiTsiatlreyG I79-70 Employee Payroll #__________________________________ 69-60Reason for ReviewAnnualP romotionPeer AppraisalUnUsatisfactory PBeloerw 60formancehistory and reasons for leaving, and also details gaps in history Merit9. En t to which anOthOer _ ____100-90 //Add ohef Irennctre todo Puctooliry Pcyeriod__ _______ ______________________p_lola_yt_ioe_e f_n s, a o Dllonatws sd ade of lahfaeretst aes ty aThpno cope extd coraismaennlpd _auc_n_y pt r__les, oraisal date P_o_in__ts__em _u____t_h _er_ led a 79-70Date employee began present position ___// // ScVGhedu pp89-80 ________regu o_licies. eswork performot aanpcpelic ina rbele. Averassiggen pd foor aints fn oovr eeraacll ph ReraftUoinrmg wa e Sin struatces ttiohne ems: Caprloefuyleleys p everalufoartem eamncepl. Ioynx. Pain lation to the essential functioInshin the .lo hceacle ak Rnad wtingr bIndic edic te N/A if nof tiht e joBb69-60 itoe tx hthat at Cw 60 Includes disclosures protecting employer from liability number in the corresponding Points bo10.o ts will be totaled and a O Per nce score.PointsDefinitions of Performance Ratings100-90 Interpersonal RelationshipsThe extent toOO which an employee is willing and demonsntrat Ntaes eteededGVrman89-80is recogunizatstandinble ags beinPerg faforr smuanpce ierios exr to ocep tiothnal in a oro co IImnpd comropvrmmeomevemunicent is necesI.79-70fo ce is deficient in certain e abiliwty tll areas andsary 69-60therws.ith co kers, sopuerapertev, wisoaorrs, srek aas. Iubordinates VVery GoodResults clearly exceed mosnd/oioun tside cotacts. UU lts ar eneray unrequirnse immatisfeacditaotre imypRresovuUement. N erit incraccepease stabhle aould bnd e at p e g Belolw 60 Includes a ComplyRight guide to help you screen and ren a co tJy anosid ir ots achieved nhis ratino mg100-90. Pointso quiremnsienstts. Pent berasifos.rmance is of high q11.ualiudgomenstnrattes pThre extoper jenudgt to wmgraenhicnt ateh ad tnd den emo incidipsiolovidyn-eue a ls with tOV o sormaCnoce smptetanendat ardns od depf the jenodba.ble p erdem s when necessN/ANary.GGofood foarkminag snceki. Ml eetsot Applicable or tGo on to ra79-7089-80te.the per m interview candidates the right wayPerformance FactorsRating ScaleU I 69-60 100 - 90 Below 60Supportive Details or Commentsl p mance 1.QualityThe extent to which an emRpalotey eemesp loyees VovO eralerfo100-90in coPmopinartsison to position duties and responsibilities.Oerutsy Gtanodinod g89 - 80work is accurate, thorough and neat. r89-80 V ber of Factors RatedImprovement Needed69 - 60Total PointsG I Num79-70 =Overal RatingGood79 - 70 69-60Item No. A2179XX*2. The extent to which a n UBelow 60 Points UnsatisfactoryBelow 60Complete all of the following sectionsProducee pficiently in a spnifecificieand pt voerl1umio.d A O100-90em tivitryo duces a sigr new a79-70f wpoloryk ef e ccomplishmVGents o 89-80 bilities demonstrated since last review____________________________________________________Price per pkg/50. Size: 17" x 11".o I f time.2.UB69-60o ____________________________________________________________________________________________________________ elow 60Specific areas of needed improvement __________________________________________________________________________*Replace XX with your state abbreviation (e.g. A2179FL). 3.Job KnowledgeThe extent to whic____________________________________________________________________________________________________________h O100-90Pointsan employee possesses the practical/t3. ecRhnicecoaml mendaVt89-80 ____________________________________k Gions for pr79-70 ofessional development (seminars, training, schooling, etc.) nowledge required on the job.____________________________________________________________________________________________________________I 4. Absences: NuUmB69-60Number of days ________________________ elow 60________________________________________ber of incidents 50-State Compliant Job Application 4.ReliabilityThe extent to which angployees Comme nts 100-90*Points Employees Signature* _____________________________________________Em O____________________________________________________________________________________ 89-80employmee cpletan bion ae rnd follow-upelied upon rega.rdin V79-70task co ____________________________________________________________________________________________________________G *If necessary, additional sheets may be attached.Discussed with inUI divual oB69-60 / / *I acknowledge that this Performance Appraisal was discussed with me. nlo_______________id ew 60 d Ye / /Application for Employment 5.Attpendloyaee inces punThce exttual, oenbst tero wves phicrh aescrnF oiblloed w-up requesVOt ed/desire100-90s PoNinotsFollow-Up Date_________________em ure89-80 Date _________________Please Print For businesses that operate in more than one state, theseSave timework break/meal periods, and has an E valuators SignGat I oe is produ 79-70 / / ________________________________________________________________Employment History Employment History acceptable overall attendance record. 69-60Starting with your most recent employer, provide the folowing information. You may include any verified work performed on a volunteer basis. Starting with your most recent employer, provide the fol owing information. You may include any verified work performed on a volunteer basis.Ufo Bect is designed to provide acurate and authoritative information. However, it is not a substitudtuec fionrg l oerga dli sadtrvibicuet ianngd t hdiose ps rnoodtu pcrto isv indoet l leigaabll eo pfoinr iaonnysdoanm anagye ss paercisifinicg f aocuttsoofrtsheer vuiscee s . Th low 60 in ianbtailnittyntoo tue:s eT hthisis6.end o which an9 mplyRight, Inc. O Trhpor rmation is provided with the ue nudrgeersdt atno dcionngs tuhlta ta nan ayt tpoerrnseoyn c oorn ecenrtnityin ign yvooluvre pda irnt iccruelaatri nsgit,u partoiornwanithdathniyr ds ppeacritfiiecs .questions or concerns you may have.Eeqxuuaal al ocrcieesns ttao ption arognrad gmse, sndeerr ivicdees antintd ey), rmapcleo, cymoelont or, replpiogritounn, nitaiets iions aal ovariliagbinl, ce tio atizlel pnsehrispo, ans wge, dithisoaubility, genetic information, or any os with duplicateem ee pencerfeormThs we extork went tith little o 222 Co V100-90i sp raoppdruocvt.ed Y ofuo a r ruse by the purchaser only. This form may not be shared publicly oEmployerTelephone # Employer Telephone #basis protected by federal, state, and/or local law.t regard to sex (including pregnancyt, herapplications capture job-related information you need. Indpelopyervision.A2210 r G Im o easy 89-80 PointsStreet address() StateStreet address() State CityCity ways to reorder: hrdirect.com800-999-9111TwStarting job title/final job titleDates employedMonthYear MonthYear Starting job title/final job titleMay we contact for reference?/ E-mail: to / no sup79-70In accordance with the Ampeprliiccaantis won aith Dnd/oisr iabnitlietrives Aiew pct aroncde/sos sr ahpopullid ncabolte sify ttathe ae Hnud lmaon Rcal lesaowusr, aceps Dpliecpaanrtts rmeenqtu. Eirixnag rmpelaess oonf rablee asonablewarning slips. U IB69-60Immediate supervisor and title (for most recent position held)May we contact for reference?/ E-mail: to / Immediate supervisor and title (for most recent position held)Dates employedMonthYear MonthYearaccommodations for the a pplication process; providing written maetnetr; oialr ms in aodn aifyilnteg trneastte finog crmoant sdiuticoh ans.s braile,Theyre attorney developed and carefully worded to include Bestsellerelow 60Yes No Later Yes No Latera Why did you leave? Why did you leave?lacrcgoe pmmriondt oatr aionus idino rcleudcoe mrdinakgi; ung a csing a shangige tn lo tanhge auage interpreter; using specialized equipmSummarize the type of work performed and job responsibilities. Summarize the type of work performed and job responsibilities.Name __________________________________________________________________Applicant ID # _____________________ the correct language and proper legal disclosures requiredWhat did you like most about your position? What did you like most about your position?Telepho LastStreetCel First() Middle StateZIP Code by all federal and state laws. Consecutive Employee Warning Report Performance AppraisalWhat were the things you liked least about the position? What were the things you liked least about the position?EmployerTelephone # EmployerTelephone #Address __________________________________________________________________________________________________Street addressCity() StateStreet address() State ne # _________________ ular/Other Phone # ________________ E-mail Address ____________________________ () CityCity Starting job title/final job titleDates employedMonthYear MonthYear Starting job title/final job titleDates employedMonthYear MonthYear/ /Immediate supervisor and title (for most recent position held)May we contact for reference?/ to/ Immediate supervisor and title (for most recent position held)May we contact for reference?/ to/Position(s) applied for _____________________________________________________ Date of application __________________E-mail: E-mail:Referral Source (e.g., Walk-in, Job Posting, Companys Website, etc.) _________________________________________________________Yes No Later Why did you leave? Yes No LaterIf necessary, best time to call you is :PM Will you travel if job requires it? Yes NoExcludes criminal questions in compliance Document all employee infractions, especially those with multipleSimplify the performance review process and provide Why did you leave?AM______________Summarize the type of work performed and job responsibilities. Summarize the type of work performed and job responsibilities. HomeCelular/OtherYes No Other tehdianca tl cimoen odifft ifoon, ar reare tsonhse rre aelantey dd taoy ys oour tr imreliegs wionh, ean y disoau abilirte y, What did you like most about your position? What did you like most about your position?May we contact you at work? .or a mIf yes, work number and best time to call: ______________ unavailable to work?___________________________________ with ban the box laws occurrences. Distribute written warning slips for up to threeemployees a clear way to measure their progress.What were the things you liked least about the position? What were the things you liked least about the position?AM ____________________________________________________ ________________________________ : PM Will you work overtime if required? .YesNo( ) EmployerTelephone # EmployerTelephone #Street address() StateStreet address() State CityCity If you are under 18 and it is required,If no, please explain:_______________________________can you furnish a work permit?N/A Yes No________________________________________________ infractions and record the dates and reasons for each warning. If no, please explain:_______________________________ Are you able to pewrfiotrhm o rt hwei theossuetn rteiaals founnacbtlieo nacsc oomf tmheo djoabti foonr) w? hich Excludes salary history questions in complianceUses a simple 100-point rating scale with comment Starting job title/final job titleDates employedMonthYear MonthYear Starting job title/final job titleDates employedMonthYear MonthYearImmediate supervisor and title (for most recent position held)May we contact for reference?/ to/ Immediate supervisor and title (for most recent position held)May we contact for reference?/ to/Have you submitted an application here before? Yes No you are applying (Yes No Later E-mail: Why did you leave? Yes No Later E-mail:Why did you leave? This question is not designed to elicit information about an applicant\'s disability. If yes, give date(s) and position(s):____________________ P alcecoasmem dood naotito pnr oovri wdeh einthfoerrm acatcioomn mabodouatti othne i se xniestceensscaer yo.fTah edsisea ibsisluitey,spmaaryti cbuel ar________________________________________________ addressed at a later stage to the extent permit ed by law. with the salary history ban and equal pay lawsCapture necessary documentation on repeat areas to explain the ratingsSummarize the type of work performed and job responsibilities. Summarize the type of work performed and job responsibilities.What did you like most about your position? What did you like most about your position?Have you ever been employed here before? .Yes NoYes NoIf yes, give dates:/ /To ______________Need emore information about the/ /jobs ssential functions to respondWhat were the things you liked least about the position? What were the things you liked least about the position?From ____________ Drivers license number required if driving may be required in the Is this application a request for reemployment fol owing an extendedjob for which you are applying:State __________Includes a ComplyRight guide to help you screen offenders and actions takenIncludes a ComplyRight guide to help correctly EmployerTelephone #StateEmployerTelephone #State () Street address()military leave of absence from this company? .Yes No ____________________________________Street addressCityCity If yes, additional information may be requested. Have you ever been bonded? .YesNoStarting job title/final job titleDates employedMonthYear MonthYear Starting job title/final job titleDates employedMonthYear MonthYearImmediate supervisor and title (for most recent position held)May we contact for reference?/ to/ Immediate supervisor and title (for most recent position held)May we contact for reference?/ to/Are yContainsYes No Have you entered into an agreemteintito wn iathgr aeneym feonrtm) tehra etm mpilgohyte, ri no ra ny and interview candidates the right way Includes a ComplyRight guide to help document conduct effective employee evaluationsou lawfuly authorized to work Yes No Later E-mail: Why did you leave? Yes No Later E-mail:in the United States?Date available for work .______________ otahye, rr epsatrrtiyct ( ysuocuhraabs iali ntyo tnoc womorpke for our company?. . .YesNo/ / wWhy did you leave?Summarize the type of work performed and job responsibilities. If yes, please explain: _______________________________ Summarize the type of work performed and job responsibilities.W hat is your desired salary ra tor y Part-Time________________________________________________manda nge or hourly rate of pay?________________________________________________$ _______________________ Per _________________ NOTE TO RHODE ISLAND APPLICANTS: This company is subject to the states workers compensationand discipline employees the right wayWhat did you like most about your position? What did you like most about your position?Type of employment desired: Full-Time Temporary laws (Chapter 29-38) unles otherwise noted below (employer to list applicable exemptions): A0019Long Form Item No. A2192What were the things you liked least about the position? What were the things you liked least about the position?disclosures for Yes No ____________________________________________________ Educational Co-Op SeasonalPage 2 Page 2Will you relocate if job requires it? ____________________________________________________all 50 states. AN EQUAL OPPORTUNITY EMPLOYER Page 1 Long Form; 4 pagesA0374Short Form Item No. A2187 Price per pkg/50. Standard: 8" x 11". Price per pkg/50. Long form: 17" x 11". Short form: 8" x 11".Price per pkg/50. 4-Part carbonless. Size: 8" x 11". 16 Employee Management FormsEmployee Management Forms17'