(717) 471-4273
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APPLICANT TO COMPLETE (ANSWER ALL QUESTIONS)
LIST YOUR ADDRESSES OF RESIDENCY FOR THE PAST 3 YEARS
EMPLOYMENT HISTORY
EMPLOYER NAME
ADDRESS
CITY, STATE, ZIP
CONTACT PERSON
PHONE NUMBER
FROM: MO/YR
TO: MO/YR
SALARY/WAGE
REASON FOR LEAVING
EDUCATION
RESUME
By checking, I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
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1325 Fruitville Pike, Lancaster, PA
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