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Career Application

Personal Information Incomplete information could disqualify you from further consideration.

Name

Address

Home Phone

Mobile Phone

Yes, I am eligible to work in the U.S.

Yes, I am at least 18 years or older. (If no, you may be required to provide authorization to work.)

I can work any shift.

I am able to perform the essential functions of the job for which I am applying, with or without a reasonable accommodation.

Employment Desired

Date Available

Minimum Salary Requirements

Position you are applying for

	I am currently employed
	Yes, Prince & Izant may contact my current employer.

Referral Source

How did you hear about us?

Please explain

Have you ever worked for this company? If so, Explain.

Do you know anyone who works for our company?

Education	Name and location of school	Years Attended	Degree Received	Major
High School
College or University
Trade School

References Give the names of three persons not related to you, whom you have known at least three (3) years.

Name	Company	Years Acquainted
Address	Phone	Email

Name	Company	Years Acquainted
Address	Phone	Email

Name	Company	Years Acquainted
Address	Phone	Email

Employment History Include your last three (3) positions of employment history. Incomplete information could disqualify you from further consideration.

Employer Name	Job Title	Start Date	End Date
Address		Phone Number Yes, you may contact this employer
Immediate supervisor and title		Summarize the nature of work performed and job responsibilities
Reason for leaving		Hourly Rate/Salary

Employer Name	Job Title	Start Date	End Date
Address		Phone Number Yes, you may contact this employer
Immediate supervisor and title		Summarize the nature of work performed and job responsibilities
Reason for leaving		Hourly Rate/Salary

Employer Name	Job Title	Start Date	End Date
Address		Phone Number Yes, you may contact this employer
Immediate supervisor and title		Summarize the nature of work performed and job responsibilities
Reason for leaving		Hourly Rate/Salary

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, Explain.

Computer Skills (please describe)

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Prince & Izant to hire me. If I am hired, I understand that my employment will be "at-will" and either Prince & Izant or I can terminate my employment at any time and for any legal reason, with or without cause and without prior notice. I understand that no representative of Prince & Izant has the authority to make any assurance to the contrary.

By checking the box below I attest that I have given to Prince & Izant true and complete information on this application. No requested information has been concealed. I authorize Prince & Izant to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this may constitute cause for the denial of employment or immediate dismissal.

I hereby acknowledge that I have read, understand and agree to each and every one of the above statements.

THIS APPLICATION IS ONLY VALID FOR 60 DAYS FROM TODAY.

Prince & Izant is an equal opportunity employer and does not discriminate on the basis of race, color, religion, national origin, citizenship status, ancestry, age, sex (including pregnancy), gender, sexual orientation, marital status, physical or mental disability, military/veteran status, genetic information or any other legally protected classification.

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Career Application

Personal Information Incomplete information could disqualify you from further consideration.

Employment Desired

Referral Source

References Give the names of three persons not related to you, whom you have known at least three (3) years.

Employment History Include your last three (3) positions of employment history. Incomplete information could disqualify you from further consideration.

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