------------------------- Your Information -------------------------
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Please type your full name.
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------------------------- Submitting For -------------------------
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Desired Hours per Week? Part-Time Full-Time
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Days Available? Mon-Fri Only Sat-Sun Only All Days
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Shifts Available? Early Morning/Morning Afternoon/Evening Any Open Shifts
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Do You Have Transportation? Yes No
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----------------------------- Work Status -------------------------------
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Are You 21 or Older? Yes No
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Highest Grade Completed: HS: Freshman HS: Sophomore HS: Junior HS: Senior College: Freshman College: Sophomore College: Junior College: Senior College: Grad School
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------------------------- Liberty Hills History -------------------------
Have you ever interviewed with Liberty Hills before?
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*Please Select* Yes No
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If yes, list date & job title of most recent interview:
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Have you ever been employed with Liberty Hills before?
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*Please Select* Yes No
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If yes, list date, job title, location of most recent position:
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Names of other employees in this company with whom you are acquainted?
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------------------------- Background -------------------------
Have you ever been convicted of a crime, excluding misdemeanor and summary offenses?
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*Please Select* Yes No
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Have you ever been convicted of driving under the influence of alcohol or drugs?
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*Please Select* Yes No
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Have you ever been fired, asked to resign, or been subject to disciplinary action in your current or previous employment?
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*Please Select* Yes No
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Have you ever been counseled or disciplined for cash handling discrepancies?
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*Please Select* Yes No
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Are you able to perform all the essential functions of the job for which you are applying with or without reasonable accommodations?
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*Please Select* Yes No
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If hired, do you agree to abide by the safety rules of the company?
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*Please Select* Yes No
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Have you ever been counseled or disciplined for being late to work or school?
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*Please Select* Yes No
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If hired, can you provide proof of eligibility to work in the United States prior to starting work?
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*Please Select* Yes No
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----------------------- List Completed Education -------------------------
High School (Name, Address, Major, and Degree/Diploma/License or Certificates):
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College (Name, Address, Major, and Degree/Diploma/License or Certificates):
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Graduate School (Name, Address, Major, and Degree/Diploma/License or Certificates):
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--------------------------- Employment History ----------------------------
--------- Job 1 Info ---------
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--------- Job 2 Info ---------
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--------- Job 3 Info ---------
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----------------- Additional Information -----------------
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---------------- Complete Code to Submit -----------------