| Personal Information |
| Date: |
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| Are you a returning Candy kitchens employee? |
Yes No |
| If so, please indicate year and location: |
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| Last Name: |
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| First Name: |
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| Middle Name: |
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| Summer Address: |
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| Summer Phone: |
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| Permanent Address: |
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| Email Address: |
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| If you are under 18, can you furnish a work permit? |
Yes No |
| Are you legally eligible to work in the United States? |
Yes No |
| Country of Origin: |
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| Do you have any annual earnings limitations? |
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| Education |
| High School |
| Name and Location: |
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| Years completed: |
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| Did you graduate? |
Yes No |
| Degree or diploma received/course of study: |
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| College |
| Name and Location: |
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| Years completed: |
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| Did you graduate? |
Yes No |
| Degree or diploma received/course of study: |
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| When does your next school semester begin? |
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EMPLOYMENT HISTORY Please give an accurate and complete listing of all full-time and part-time employment. Start with present or most recent employment. |
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| Name of Contact: |
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| Job title or description of your work: |
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| Employed: (Month and Year) |
From: to: |
| Compensation: |
Start: Last: |
| Reason for leaving: |
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| Company Name: |
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| Company City, State, Zip: |
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| Name of Contact: |
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| Job title or description of your work: |
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| Employed: (Month and Year) |
From: to: |
| Compensation: |
Start: Last: |
| Reason for leaving: |
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| Company Name: |
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| Company Address: |
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| Company City, State, Zip: |
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| Company Phone: |
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| Name of Contact: |
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| Job title or description of your work: |
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| Employed: (Month and Year) |
From: to: |
| Compensation: |
Start: Last: |
| Reason for leaving: |
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APPLICANTS STATEMENT AND AUTHORIZATION (Read carefully prior to submitting) |
The Serectary of Health and Human Services has determined that certain diseases, including hepatitis A, salmonella, shigella, staphylococcus, streptococcus, giardia and conpylobacter may prevent you from serving food or handling food equipment in a sanitary or healty fashion. An essential function of this job involves habndling and serving food, food service equipment and utensils in a sanitary and halthy fashion. Is there any reason why you cannot perform the essential functions of this job?
Yes No |
If yes, please explain:
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Under Maryland Law an employer may not require or demand any applicant for employment or prospective employee or any employee to submit or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and is subject to a fine not to exceed $100.00.
The facts set forth in my application are true and complete to the best of my knowledge. I understand that if employed, any false statement on this application may result in my dismisssal.
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