Employment Form

Whalen Pre-Employment Questionnaire - An Equal Opportunity Employer

* Required fields
First Name*
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Last Name*
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Address Line 1
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Address Line 2
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City
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State/Province
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Zip
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Country
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Phone Number*
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E Mail Address*
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Social Security Number
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Date Available*

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Desired Salary
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Position Applied For*
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Referred By
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Are you a citizen of the United States?*
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If no, are you authorized to work in the U.S.?

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Have you previously worked for The Whalen Company?*

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If so, when?
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Have you ever been convicted of a felony?

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If yes, explain.
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EDUCATION
High School
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High School Address
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Did you graduate?

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College
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College Address
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Degree
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Did you graduate?

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Other Education
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Address
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Degree
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Did you graduate?

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REFERENCES
Please list 3 professional references
Full Name
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Relationship
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Company
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Phone Number
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Address
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Full Name
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Relationship
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Company
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Phone Number
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Address
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Full Name
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Relationship
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Company
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Phone Number
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Address
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PREVIOUS EMPLOYMENT
Company
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Phone Number
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Address
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Supervisor
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Job Title
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Starting Salary
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Ending Salary
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Employed From

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To

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Reason for leaving?
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Company
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Phone Number
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Address
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Supervisor
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Job Title
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Starting Salary
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Ending Salary
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Employed From

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To

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Reason for leaving?
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Company
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Phone Number
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Address
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Supervisor
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Job Title
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Starting Salary
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Ending Salary
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Employed From

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To

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Reason for leaving?
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MILITARY SERVICE
Branch of Military
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From

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To

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Rank at Discharge
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Type of Discharge
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If other than honorable, explain
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IT IS UNLAWFUL IN THE STATE OF MARYLAND TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
SIGNATURE OF APPLICANT*
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DISCLAIMER AND SIGNATURE
"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause or notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause or notice, at any time by the company."
SIGNATURE*
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NOTICE OF DRUG SCREEN
The Whalen Company is a progressive employer concerned with the health and safety of all its employees, as well as the safety of the general public. As a result, IN ORDER TO BE QUALIFIED FOR EMPLOYMENT WITH THE WHALEN COMPANY, ALL APPLICANTS WHO HAVE RECEIVED A CONDITIONAL OFFER OF EMPLOYMENT WILL BE REQUIRED TO PASS A DRUG SCREEN. This drug screen will require the applicant to provide a urine sample which will be tested for controlled substances.

I HAVE READ AND UNDERSTAND THE NOTICE OF DRUG SCREEN
SIGNATURE*
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* Required fields
The Whalen Company respects your privacy. Under no circumstances will we furnish or distribute your personal information to third-party organizations, entities or companies.
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