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Contact Information

Phone: 765-649-8111
Toll Free: 1-800-428-6306
FAX : 765-641-7261

Postal address
3273 N. State Rd. 9
Anderson, IN 46012

Email- Click here

Hours
11:00 am to 5:00 pm Monday - Thursday
(Fridays & Saturdays by appointment only)
 

 

Official PayPal Seal

 
 
Application for Employment
Pre-Employment Questionnaire
Equal Opportunity Employer
 
 
Personal Information

 

       
Position applying for          
           
Full Name   Email Address      
Street Address Phone    
Address (cont) City    
State

Zip    
Date you can start Referred by    
Salary Desired        
Currently Employed? Yes  No If so, may we contact your current employer? Yes  No    
Ever applied to this company before? Yes  No Where? When?
 

Education History

       
           
High School Graduate? Yes  No    
College Graduate? Yes  No    
Trade, Business or Correspondence School Graduate? Yes  No    
           
General Information        
           
Subjects of special study/research
Work or special training/skills
   
           
U.S. Military or Naval Service Rank    
           
Former Employers        
           
Date
Month & Year
Name & address of Employer Salary Position Reason for leaving
         
From 
To    
From 
To    
From 
To    
From 
To    
         
Personal References Give below the names of three persons not related to you, whom you have known at least one year.
Name Address Business   Years known
       
Authorization

"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 representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities act (ADA) and other relevant federal and state laws."


Date


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