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Personal Information
Date
Name
Street Address
City
State
Zip
Phone Number
Cell Phone
Email Address
Employment Desired
Desired Position
Any other Desired Position
Starting Date
General Information
How many hours are you willing to work per week?
When can you begin working?
Are you willing to work overtime?
Requested Wages
Please check shifts your are NOT AVAILABLE to work
If employee referral, please provide the employee's name.
Have you been employed with Shoreline Vision before?
If yes, when?
Education History
Name of School
City
State
If no, indicate expected date:
Type of degree
GPA
Employment
If yes, please explain
Employment History
Employer Name
City
Zip
State
Your Position
Starting Date
Ending Date
Position Duties
Supervisor Name and Title
Employer Name
Starting Pay
Ending Pay
Reason for Leaving
Employment History 2
Employer Name
City
Zip
State
Your Position
Starting Date
Ending Date
Position Duties
Supervisor Name and Title
Employer Name
Starting Pay
Ending Pay
Reason for Leaving
Employment History 3
Employer Name
City
Zip
State
Your Position
Starting Date
Ending Date
Position Duties
Supervisor Name and Title
Employer Name
Starting Pay
Ending Pay
Reason for Leaving
Upload Resume
Upload
References
Name
Address
Business
Yrs Known
Authorization

“I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed, falsified statement on the application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I grant Shoreline Vision the permission to perform a background check on past employment, criminalactivity, and to perform a credit check. I also give them the permission to perform a drug test. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) or other relevant federal and state laws.”

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