First Name: * Last Name: * Address Line 1: City:* State: * ZIP Code: Country: Home Phone Number Work Phone Number Can we call you at your current work phone?: --- Yes No Personal cell Phone Number * Alternate Phone Number E-mail address: * Are you currently employed? * --- Yes No May we contact your present employer? * --- Yes No On what date would you be available to work? * Are you able to work * Full Time: --- Yes No Part Time: --- Yes No Are you able to work Temporary: --- Yes No Contract: --- Yes No Are you currently on "Layoff" status and subject to recall? --- Yes No Are you currently self employed? --- Yes No Description of current or past self employment Description Related Technical Experience.
Have been convicted of a felony? --- Yes No If yes description of felony How long have you lived at your current address?: months How long do you expect to live in your current area?: months Internet speed you currently have at your home? Are you willing and able to work weekends & evenings? --- Yes No Would this job be your only means of Support? --- Yes No If no description of other support How many days did you miss work in the last Six Months? How many days did you miss work in the last year? How well do you verbally communicate in English? --- Not so good Ok Good Excellent Have you ever been on call for a client or employer? --- Yes No How many hours a week can you work? Hours Description of available work schedule
What do you expect as a minimum hourly rate * ($$)
Previous or Current Employer Info: * Employer Name Employer Phone Your Title Reason for Leaving Work performed Final Salary / Hourly Rate * Employment Starting Date (Month/Year 12/2010) * Ending:
Previous Employer Info: * Employer Name Employer Phone Your Title Reason for Leaving Work performed Final Salary / Hourly Rate *
Employment Starting Date (Month/Year 12/2010) * Ending:
How did you learn about this Opportunity? Select One: --- Search Engine News Article craigslist.com Flexjobs Referred By Other Mail from avartech.com Word of Mouth trivalleyjobs.com Monster.com Other
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