Employment Application – by RLS
Employment Application – by RLS
Position Applied For
Part-time Phlebotomist/UDS Collector Fayetteville, AR
PRN Phlebotomist/UDS Collector Fayetteville, AR
Part-Time UDS Collector, Jonesboro, AR
UDS/Phlebotomy Collector-PRN Hot Springs, AR
UDS / Phlebotomy Collector – PRN
Position Applied For
Today’s Date
Availability
Select all days you are available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday available from
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Monday available to
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Tuesday available from
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Tuesday available to
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Wednesday available from
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Wednesday available to
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Thursday available from
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Thursday available to
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Friday available from
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Friday available to
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Saturday available from
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Saturday available to
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Sunday available from
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Sunday available to
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If hired, when could you begin work?
How many hours would you like to work each week?
Personal Information
Last name
First name
Middle initial
Email
Address
City
State
Zip code
Home phone
Cell phone
Work phone
May we contact you at work?
Yes
No
Are you over the age of 18?
Yes
No
Have you ever been employed under any other name(s)?
Yes
No
If yes, list other name(s)
How did you hear about this job opening?
Web page
Newspaper
Human resource office
ARMO employee
Career fair
Other
If “ARMO employee,” please list their name
If “other,” please explain
Are you authorized to work in the U.S.?
Yes
No
If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986
Education
High School
Number of years complete
Graduated
Yes
No
If no, highest grade completed?
Degree and major
College
Number of years complete
Graduated
Yes
No
If no, approximate number of credit hours completed?
Degree and major
Other
Number of years complete
Graduated
Yes
No
If no, approximate number of credit hours completed?
Degree and major
Skills
Office and computer skills
Transcription
Ten key by touch
Typing
Words per minute
Software applications
Microsoft Office
Other
Other
Licenses and Certifications
Are you currently
Registered
Licensed
Certified
Not applicable
Are you eligible for
Registration
Licensure
Certification
Not applicable
Professional License, Certification, or Registration
State
ID number
Expiration date
Professional License, Certification, or Registration
State
ID number
Expiration date
Military Service
Complete this section if you served in the U.S. Armed Forces
Branch of service
Date of service from
Date of service to
Describe duties and any special training
Rank at discharge
Discharge status
Honorable
Dishonorable
Other
Other
Employment History
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List all employment including military and volunteer service starting with the most current position held. Show employment history for at least 10 years or from the time you left school. Explain gaps in employment history. You may attach a resume, but you must complete the employment section. This information will be used in reference checks. Failure to answer all items in the following sections may eliminate you from further consideration.
Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 2
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Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 3
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Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 4
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Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 5
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Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 6
arrowup6
Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
May we contact for references?
Yes
No
Duties
Employment History 7
arrowup6
Position title
Organization name
Organization address
Employment start
Employment end
Salary start
Salary end
Full-time or part-time?
Full-time
Part-time
If part-time, please indicate hours per week
Supervisor’s phone number
Supervisor’s name
Supervisor’s title
Reason for leaving
If you are human, leave this field blank.
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