NEWHIRE_APPGD_JAN12_12552

We receive applications and hire employees without regard to race, color, sex, religion, age, genetic information, national origin, marital status, disability, veterans status and citizenship status, or any other protected category. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in our organization.

PERSONAL INFORMATIONName___________________________________________________________________________

Previous address __________________________________________________________________ How long did you live there?____________________________________

Are you over the age of 18? • Yes • No If no, employment is subject to verification that you are of minimum legal age.

Are you currently eligible to work in the U.S.? • Yes • No Can you provide documentation that you are legally eligible to work in the U.S.? • Yes • No

EMPLOYMENT INFORMATION

Position applying for______________________________________________________________

Type of employment • Full Time • Part Time

What days and hours are you available to work? Days____________________________________ Hours_________________________________________________________

Have you ever been bonded? • Yes • No

Have you ever been convicted of a crime, pled no contest or had adjudication withheld? • Yes • No If so, explain__________________________________________ ______________________________________________________________________________________________________________________________________________

Do you use illegal drugs? • Yes • No

Does your present employer know of your plans to change employment? • Yes • No Why do you desire to make a change?_____________________

______________________________________________________________________________________________________________________________________________

Have you ever held a position of trust (handling money or confidential material)? • Yes

Do you have steady transportation to work? • Yes • No

Have you ever been discharged or asked to resign? • Yes • No

Are there any other experiences, skills, or qualifications you have that specifically relate to working here?__________________________________________________________

Do you have any friends or relatives that currently work here? • Yes • No

Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation? • Yes • No

EDUCATION INFORMATION

SCHOOLING

GRAMMAR ORHIGH SCHOOL

TRADE BUS., OR CORRESPONDENCEGRADUATESCHOOL

Describe any other specialized or professional training (such as business, technical or nursing school). Include study courses given through public or private employment, State whether degree or certificate was received.____________________________________________________________________________________________________________

First Middle Initial Last Present address___________________________________________________________________ Home or nearest phone_______________________________________

No. Street City State Zip

No. Street City State Zip

How long have you lived at above address?___________________________________________________________________________________________________________

YEARSCOMPLETED

GATOR’S DOCKSIDEAPPLICATION FOR EMPLOYMENT

DEGREE REC. AND MAJOR SUB.

• No When?_____________________________________________________________________________

Have you ever been refused bond? • Yes • No If so, state reason and date.____________________

Name_________________________________________________________________

NAME OF SCHOOL

• No

Social Security No.________________________________________

Date available for work________________________________________

What salary or pay rate do you expect?___________________________

.

Date:____________________________

LOCATION

ANEQUAL

OPPORTUNITYEMPLOYER

DID YOUGRADUATE?

Shift Preference • Before 4pm • After 4pm • Any

Have you ever applied for a job with us before? • Yes

NEWHIRE_APPBACK_JAN12_12552

PRIOR WORK RECORD (Start with most recent or present employer) 1) Name & Address of Most Recent Employer

Telephone No.

Immediate Supervisor (Name & Position)

Date Hired___________________________________________ Starting Rate____________________________________________

Your Job Title & Duties

Date Left____________________________________________ Last Rate_______________________________________________

Reason for leaving:

2) Name & Address of Most Recent Employer

Telephone No.

Immediate Supervisor (Name & Position)

Date Hired___________________________________________ Starting Rate____________________________________________

Your Job Title & Duties

Date Left____________________________________________ Last Rate_______________________________________________

Reason for leaving:

3) Name & Address of Most Recent Employer

Telephone No.

Immediate Supervisor (Name & Position)

Date Hired___________________________________________ Starting Rate____________________________________________

Your Job Title & Duties

Date Left____________________________________________ Last Rate_______________________________________________

Reason for leaving:

May we contact the employers listed above? __________ If not, indicate by No. which one(s) you do not wish us to contact_______

REFERENCES (Do not list relatives or former employers) Name________________________ Address _______________________ Phone______________________ Occupation___________ Name________________________ Address _______________________ Phone______________________ Occupation ___________Name________________________ Address _______________________ Phone______________________ Occupation___________

The facts set forth above in my application for employment are true and complete. I understand that if employed, false statements or omission of information on this application, a. resume, or other applicant information provided may be considered sufficient reason for dismissal. I understand that consumer reports which may contain public record information may be requested from the reporting agency. These reports may include information as to my character, work habits, performance, and experiences along with reasons for termination of past employment from previous employers. Further, I understand that you may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigative consumer report.

I authorize the use of any information in this application to verify my statements, and I authorize the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information. I understand that employment at this organization is on an "at will" basis, and includes no guarantee, contract, or promise of employment for any specificlength of time.Signature of Applicant________________________________________________Date____________________________________________ Signature of Applicant Date

Address: Phone: Occupation: Name_2: Address_2: Phone_2: Occupation_2: Name_3: Address_3: Phone_3: Occupation_3: Date Hired: Name of Employer: Yes or No: Date: First, Middle Initial, Last: Social Security No: Present Address: Phone No: Time at Current Residence: Time at Previous Address: Previous Address: Position Applying for: Date Available to Work: Desired Salary_Pay Rate: Days: Hours: When: Reason_Date: Make a Change: Experience, Skills, Qualifications: Name: Degree Rec: _Major Sub_1: _Major Sub_2: _Major Sub_3:

Years_1: Name of School_1: Location_1: Did_You_Graduate: Years_2: Years_3: Name of School_2: Name of School_3: Location_2: Location_3: Did_You_Graduate_2: Did_You_Graduate_3: Describe Specialized or Professional Training: Yes: Choice1work: choice1eligible: choice1shift: Choice1Employment: Choice1Job: Choice1Bonded: Choice2Refused Bond: Choice2Crime: Choice2Drugs: Choice2Change Employment: Choice2Trust: Choice1Transportation: Choice1Discharged: Choice2Friends: Choice2Functions: Choice1Explaination: Employer 1: Employer 1 Telephone No: Employer 1 Date Left: Employer 1 Reason for Leaving: Employer 1 Starting Rate: Employer 1 Last Rate: Employer 2: Employer 2 Telephone No: Employer 2 Supervisor: Employer 2 Starting Rate: Employer 2 Date Hired: Employer 2 Date Left: Employer 2 Last Rate: Employer 3: Employer 3 Telephone No: Employer 3 Supervisor: Employer 3 Date Hired: Employer 3 Starting Rate: Employer 3 Date Left: Employer 3 Last Rate: Employer 3 Reason for Leaving: Employer 2 Reason for Leaving: Employer 1 Supervisor: Employer 1 Job Duties: Employer 3 Job Duties: Employer 2 Job Duties: trer