Employment Opportunities Name Social Security Number Email Phone Address City State Zip Position (s) Applying For Referred By Have you ever been convicted of a crime? (This will be checked) Yes No Are there any felony charges pending against you? Yes No Do you have a valid Maine Driver's License? Yes No Do you have auto insurance? Yes No Has your driver's license been suspended in the past 5 years? Yes No List any traffic violations or accidents in the past 3 years Would you accept full-time work (30+ hours)? Yes No Would you accept part-time/relief work (less than 30 hours)? Yes No Are you willing to work nights, weekends & holidays? Yes No If hired, on what date would you be available for work? What is your desired salary range? Have you ever been employed by this organization before? Yes No Are you eligible for employment in the United States? Yes No Do you have any physical limitations that may preclude you from performing any work for which you are being considered? (Includes lifting up to 40 pounds) Yes No Has any time restriction been placed on your eligibility for employment in the United States? Yes No Are you above the age of 18? Yes No High School Graduate or GED/HiSET? Yes No Upload your Resume (PDF PLEASE) Upload your Cover Letter (PDF PLEASE) Highest level of education Certifications Work Experience Name of Professional Reference Address of Reference Phone Number of Reference Relationship to Reference Applicant Signature I agree all provided information is accurate Date Send
