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Application for Employment |
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Pre-Employment Questionnaire |
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Equal Opportunity Employer |
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| Personal
Information |
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Date |
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| Name (Last
Name, First Name, Middle Initial) |
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Social Security No. |
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| Present
Address |
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City |
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State |
Zip Code |
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| Permanent
Address |
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City |
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State |
Zip Code |
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| Phone
No. |
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Referred by |
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| Employment
Desired |
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| Position
(Circle all that apply.) |
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Date you can start. |
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Desired
Salary |
| Driver |
Office |
Landing |
Other |
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| Are you
currently employed? |
YES NO |
If so, may we contact your present employer? |
YES NO |
| Are you willing
to commit to work from Memorial Day to Labor Day? |
YES NO |
Can you work weekends? |
YES NO |
| Potential
Drivers Only |
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| How many
tickets and points have you had in the past three years, if any? |
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| Driver's
License No. |
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Date of Birth |
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| Do we have
your permission to check your driving record? |
YES NO |
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| If yes, sign here |
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| General
Information |
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| Do
you have any physical limitations, injuries or medications that would prevent
you from completing the tasks |
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YES NO |
| associated
with the position you are applying for? (for example, lifting canoes,
driving, etc…) |
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| List any
talents or skills pertinent to this position. |
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| List any water
related experiences you have. (Canoeing, boating, swimming…) |
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| U.S Military
or Naval Service |
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Rank |
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| List your
hobbies and interests. |
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| Use the
space provided to tell us about yourself and how you will fit in with our
company. |
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Continued on other side. |
| Application for
Employment |
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| Former
Employers |
(List below your last three employers, starting
with the most recent one first.) |
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| Month and Year |
Name & Address of Employer |
Direct Supervisor |
Position |
Salary |
Reason for Leaving |
| From |
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| To |
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| From |
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| To |
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| From |
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| To |
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| Education History |
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Name & Location of School |
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Years Attended |
Did you Graduate? |
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Subjects Studied |
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| High
School |
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| College |
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| Certifications |
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| Other |
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| References
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List below three people not related to you,
whom you have known at least one year. |
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| Name |
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Phone Number |
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Relationship |
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Years
Known |
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| Authorization |
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| "I certify that
the facts contained in this application are true and complete to the best of
my knowledge and understand that, if employed, falsified statements on this
application shall be grounds for dismissal. |
| I authorize
investigation of all statements contained herein and the references and
employers listed above to give you any and all information concerning my
previous employment and any pertinent information they may have, personal or
otherwise, and release the company from all liability for any damage that may
result from utilization of such information. |
| I also understand
and agree that no representatives of the company has the authority to enter
into any agreement for employment for any specified period of time, or to
make any agreement to the foregoing, unless it is in writing and signed by an
authorized company representative. |
| This waiver does
permit the release or use of disability-related or medical information in a
manner prohibited by the American with Disabilities Act (ADA) and other
relevant federal and state laws." |
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| Date
_________________________ |
Signature |
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Do Not Write Below This Line |
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| Notes |
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| Hocking Hills
Canoe Livery |
|
www.hockingriver.com |
hhcanoe@hocking.net |
| 12789 State
Route 664 S.; Logan, OH 43138 |
740-385-0523 |
740-385-2755 |
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Application for Employment |
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