Personal Information

18 years old
Gender

Employment Desired

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Are you employed?
If so, may we contact your employer?
Were you previously employed by DOMAH?
Hours available:

Education History

Please list any subjects of relevant study/research or special skills and training here:

Work History

(List below your last 5 employers, starting with the most recent)

Professional Preferences

Please list at least 3 professional references.

Additional Information

Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge and I 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 give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand that and agree that no representative of the company has any authority to enter into any agreement for employment for any specified 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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