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First Name *

Last Name *

Phone *

Email *

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Address *

City *

State *

Postal code *

Date of birth *

Date You Can Start *

Are you a citizen of the United States? *

Yes
No

If no, are you authorized to work in the U.S.?

Do You have transportation? *

Yes
No
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How would you get to work? (own vehicle, family, friend, public transportation, uber, walking, taxi) *

Have you ever been convicted of a felony? *

Yes

No

Are you able to perform the essential functions of the position with or without accommodations? *

With Accommodations

Without Accommodations

High School Name *

Start Date *

Graduation Date or Year

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College Name

Did You Graduate

Yes

No

Degree if so

ECE Units

Yes
No

How many

Kind of employment seeking *

Full time

Part time

Temporary

Days Available *

Hours Available *

What is your desire in pay *

Employer *

Start Working Date *

When did you stop working *

Reason for Leaving *

Responsibilities *

May we contact your previous supervisor for a reference? *

Yes

No

Please upload your resume *

Please Sign Acknowledging Detaile are Correct *

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