Application for Employment at GAC Services

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9. How were you refered to GAC Services?
10. Do you have any friends or relatives who work here? If yes, please list here:
11. Have you applied to our company previously?
- Yes
- No
If yes, when?
12. Are you at least 18 years old?
- Yes
- No
13. How will you get to work?
14. Are you willing to work any shift? Nights/Weekends/Holidays?
- Yes
- No
If no, please state any limitations:
15. If applicable, are you available to work overtime?
- Yes
- No
16. If you are offered employment, when would you be available to begin work?
Indicate your final day of employment if known.

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17. Are you a United States Citizen?
- Yes
- No
If no, are you authorized to work in the United States?
- Yes
- No
18. Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?
- Yes
- No
19. What reasonable accommodation, if any, would you request?
20. Have you ever been convicted of a felony or misdemeanor?
- Yes
- No
Please explain

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22. Applicant Employment History
List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.
Employer #1 Name:
Supervisor Name:
Address
Street Address Address Line 2 City State ZIP Code
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):
Employer #2 Name:
Supervisor Name:
Address
Street Address Address Line 2 City State ZIP Code
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):
Employer #3 Name:
Supervisor Name:
Address
Street Address Address Line 2 City State ZIP Code
Job Duties:
Reason for Leaving:
Dates of Employment (Month/Year):

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Applicant's Education and Training
23. College/University Name and Address
24. Did you receive a degree?
- Yes
- No
If yes, degree(s) received:
25. High School/GED Name and Address
26. Did you graduate or receive GED?
- Yes
- No
27. Other Training (graduate, technical, vocational):
28. Please indicate any current professional licenses or certifications that you hold:
29. Awards, Honors, Special Achievements:
30. Military Service:
- Yes
- No
Branch:
31. Specialized Training:

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32. References
List two professional non-relatives who would be willing to provide a reference for you.
Reference #1
Address
Street Address Address Line 2 City State ZIP Code
Telephone:
Relationship:
Reference #2
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone:
Relationship:

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33. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:
34. Do you have: (Please select all that apply)
- A valid adult CPR/First Aid Certificate?
- Act 33/34 Clearances (done within the past month)?
- Physical with a negative TB test result completed within the past year?
35. Please upload your résumé.
Accepted file types: pdf, doc, docx.
We will accept .PDF's and Microsoft Word documents.
Name
This field is for validation purposes and should be left unchanged.

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Employer Information