Job Form

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What is your full name?(Required)
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Employment Experience

May we Contact?
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May we Contact?
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Have you ever been involuntarily terminated or asked to resign from any job?(Required)

Education

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Diploma / Degree
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Business and Professional References

General Information

Have you ever used another name?(Required)
Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work or edu-cational record?(Required)
Have you ever worked for this company before?(Required)
Do you have any friends and/or relatives working for this company?(Required)
Are you available to work?(Required)
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If hired, would you have reliable transportation to and from work?(Required)
Can you Travel if the position requires it?(Required)
Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age)(Required)
If hired, can you present evidence of your identity and legal right to work in this country?(Required)
Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation? (Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for qualified applica-nts/employees to perform essential job functions.)(Required)

Applicant Statement and Agreement

Please read and select each paragraph below; if there is anything you don't understand, please ask.(Required)

Please enter your name and date below to indicate you agree to the statements above

Vallencourt, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by applicable law.
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