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APPLICATION FOR EMPLOYMENT
3800 South Ocean Drive, uite #209, Hollywood, FL 33019
PERSONAL INFORMATION
Best time to contact (if necessary)
May we contact you there?
Foreign Languages
Are you legally eligible for employment in the US?
Optional (Not Required)
Position Code
Department Code
POSITION
Do you work evenings (past 7 PM) or weekends ?
Do you take call?
Do you work holidays (major)?
Type of employment desired
Presently employed?
Contact present employer?
Will you relocate if necessary?
Travel if necessary?
Will you work overtime if necessary?
Do you have any restrictions on the hours that you would be available to work?
EDUCATION INFORMATION
LICENSURE INFORMATION
EMPLOYMENT HISTORY/JOB EXPERIENCE (Required!)
EMPLOYMENT REFERENCES (give names of 3 employers)
DESIRED SALARY PROPOSAL (Required! This is negotiable. Salary is based on knowledge of job, productivity, and accuracy of work performed.)
Title
Starting salary
2nd Year
Desired
Minimal acceptable
Market (What you believe is average pay for the job sought)
ATTESTATION

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REQUIRED

****PLEASE READ CAREFULLY AND SIGN BELOW****

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for a definite period that may be terminated at any time without previous notice regardless of the date of payment of my wages and salary.

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