CCC App .pdf
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Original filename: CCC App.pdf
Title: Employment application (2-pp.)
Author: Windows User
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Please fill out the application and email it back to
MikeC@ordercrabs.com.
You may also drop off the application
in person or mail it to:
Chesapeake Crab Connection
2834 Columbia Ave, Lancaster, PA 17603
if you have any questions please call 866-509-2722
APPLICANT INFORMATION
Last Name
First
M.I.
Street Address
Apartment/Unit #
City
State
Phone
E-mail Address
ZIP
Driver’s License No.
Social Security No.
Position Applied for
Desired Salary $
Are you a citizen of the United States?
Have you ever worked for this
company?
Have you ever been convicted of a
felony?
YES
NO
If no, are you authorized to work in the
U.S.?
YES
NO
If so, when?
YES
NO
If yes,
explain
EDUCATION
High
School
From
Address
To
Did you
graduate?
College
From
YES
NO
Degree
NO
Degree
NO
Degree
Address
To
Did you
graduate?
Other
From
YES
Address
To
Did you
graduate?
YES
PREVIOUS EMPLOYMENT
Company
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
Date
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
YES
NO
PREVIOUS EMPLOYMENT
Company
Phone
Address
Supervisor
Job Title
Starting Salary $
Ending Salary $
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
Company
Phone
Address
Supervisor
Job Title
NO
Starting Salary $
Ending Salary $
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
REFERENCES
Please list three references.
Full Name
Relationship
Company
Address
Phone
Full Name
Relationship
Company
Address
Phone
Full Name
Relationship
Company
Address
Phone
MILITARY SERVICE
Branch
From
To
Rank at Discharge
Type of Discharge
If other than honorable,
please explain.
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I
understand that false or misleading information in my application or interview may result in my release/termination.
Signature
Date
CrabConnectionApp.2016.
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