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Keehn Service Corporation
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Employment Form
Personal Information
Name
(Required)
First
Last
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
(Required)
Email
(Required)
Are you 18 years or older?
(Required)
Yes
No
Are you either a US citizen or an alien authorized to work in the United States?
(Required)
Yes
No
Employment Desired
Employment Position Desired
(Required)
Date You Can Start
(Required)
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Month
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Year
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1920
Salary Desired
(Required)
Are you employed now?
(Required)
Yes
No
If so, may we contact your present employer?
(Required)
Yes
No
Have you ever applied to the company before?
(Required)
Yes
No
Where?
(Required)
When?
(Required)
Referred By
(Required)
Education
Grammar School Name / Location
(Required)
Number of Years Attended
(Required)
Subjects Studied
(Required)
Did you graduate?
(Required)
Yes
No
High School Name / Location
(Required)
Number of Years Attended
(Required)
Subjects Studied
(Required)
Did you graduate?
(Required)
Yes
No
College Name / Location
Number of Years Attended
Subjects Studied
Did you graduate?
Yes
No
Trade, Business or Correspondence School Name / Location
Number of Years Attended
Subjects Studied
Did you graduate?
Yes
No
Subjects of Special Study or Research Work
Special Skills
Activities (Civic, Athletic, Etc.)
Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members.
US Military or Naval Service
Rank
Present Membership in National Guard or Reserves
Former Employers
List last three employers, starting with the last one first.
Employer Name / Address
(Required)
Salary
(Required)
Position
(Required)
Reason for Leaving
(Required)
Employer Name / Address
(Required)
Salary
(Required)
Position
(Required)
Reason for Leaving
(Required)
Employer Name / Address
(Required)
Salary
(Required)
Position
(Required)
Reason for Leaving
(Required)
Which of these jobs did you like best?
(Required)
What did you like most about this job?
(Required)
References
Name
(Required)
Address
(Required)
Business
(Required)
Years Aquainted
(Required)
Name
(Required)
Address
(Required)
Business
(Required)
Years Aquainted
(Required)
Name
(Required)
Address
(Required)
Business
(Required)
Years Acquainted
(Required)
Upload Resume
(Required)
Max. file size: 10 MB.
Consent
I certify that the facts contained in this application are true and complete to the best of my knowledge 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 listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.
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