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Family Works Employment Application

Applicant Information
  Last Name* First Name* DOB*  
  Address* Apartment/Unit #  
  City* State/Region* Zip Code*  
Enter Region
  Phone* E-mail Address Would you like to receive quarterly emails from Family Works?  
Enter Int'l Number
  Social Security Number*  
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  Are you a citizen of the United States?* If no, are you authorized to work in the U.S.?  
  Have you lived outside of Wisconsin in the last five years?* If yes, please list states and dates lived there.  
  Please list and explain any legal history (including dates).*  
  Do you have a valid drivers license?* Issued in which state? Please enter your drivers license number.  
  Please list all driving citations and moving violations (including dates) within the last five years.* Do you have access to a safe, reliable vehicle that could be used to transport clients (mileage reimbursed)?  
  Position Applied For:*  
  How did you hear about us?  
Please enter information for the highest level of education completed or enrolled in.
Please provide contact information for at least 4 references.
  Please enter the number of references.
Employment History
Please provide contact information for all employers for the past 5 years.
  Please enter the number of jobs.
Additional Certifications
Do you have any other skills, qualifications, training or experience which you feel would qualify you for this position?
Special Interests/Hobbies
When you have a day off how do you enjoy spending it?

Please use the section below to upload your resume or other pertinent documents.

Resume & Other Documents
Upload Documents*
Please select all hours/shifts you are available to work.
Availability Grid
Saturday * note: every other weekend required  
Sunday * note: every other weekend required.  
Minimum number of hours per week.
Maximum number of hours per week.
Additional comments regarding availability.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I hereby authorize Family Works, Inc. to obtain the information necessary for employment verification. Additionally, I release the above stated employers from all liability whatsoever for issuing the requested information.

Signature and Date
  Signature:* Date*  
  Type your name in the signature box. By doing so, you will authorize Family Works to proceed with background checks, reference checks and employment verification.  
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