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(757) 473-0111

5201 Virginia Beach Blvd. Virginia Beach, VA 23462

Mon - Fri: 7:30 am - 7:00 pm
Sat: 7:00 am - 4:00 pm
Sun: Closed

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Employment Form

PERSONAL INFORMATION


*Please check required fields (Full Name, Full Address, Phone, Email) before submiting your form.

Full Name (First, Middle and Last Name) *(This field is required):
A value is required.

Email: *(This field is required):
A value is required.

Phone: *(This field is required):
A value is required.

Full Address (Street, Apt, City, State, Zip): *(This field is required):
A value is required.

Date of Application:


POSITION SOUGHT

Position Sought

Full time / Part Time? (Select one):

Available Start Date:

Desired Salary:

How did you learn about us?

Are you currently employed?

If so, may we contact your current employer?


Have you ever been convicted of a felony?

If Yes, please list date and type of conviction:

Are you willing to submit to a pre-employment background check?

Are you willing to submit to a pre-employment drug screening?


EDUCATION

(Include name, location, graduate? degree? Major / subject of study)

High School

College or University

Specialized Training, Trade School, etc

Other Education

Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position. May include subjects of study/research, work or special training.


PREVIOUS EXPERIENCE

Please list beginning from most recent

Dates Employed

Company Name

Location

Role/Title

Job notes, task performed and reason for leaving:


Dates Employed

Company Name

Location

Role/Title

Job notes, task performed and reason for leaving:


Dates Employed

Company Name

Location

Role/Title

Job notes, task performed and reason for leaving:


REFERENCES

(Include name, city/state, phone#, business and years known)

Reference#1

Reference#2

Reference#3

By clicking "SUBMIT" I certified 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 may have, personal or otherwise, and release the company from all liability for any damages 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 specific 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"

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