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Home
About Us
What Is PACE?
Leadership
Our Centers
Our Work
FAQs
Services
PACE Care Team
PACE Services
Participant Resources
Enrollment
Careers
Media
Newsletter
In the News
Videos
Photos
Donate
Contribute
Apparel Store
Volunteer
Calendars
Upcoming Events
Center Activity Calendars
Past Center Activity Calendars
Contact Us
Improve PACE Form
General Inquiry
Claims
Medical Records
Menu
Application
Application
Name
*
First Name
Last Name
Address
Phone
Work Phone
Email Address
*
Position Applied For:
*
Salary Desired
*
Employment Desired
Full-Time
Part-Time
Temporary
Date Available To Start
MM
DD
YYYY
Name of Client Company Applied For
Have you ever applied at PACE SEMI before?
Yes
No
If yes, state when and where you applied and/or worked:
How did you learn of our company and/or position?
Are you 18 or older?
Yes
No
Are you a citizen of the U.S. or do you have the legal right to be employed in the U.S.?
Yes
No
Can you perform the essential functions of the job, with or without reasonable accommodation?
Yes
No
Have you ever been convicted of or pled guilty or no contest to a felony?
(An affirmative response does not necessarily disqualify an applicant from employment.)
Yes
No
If yes, describe conditions:
Have you ever served in the Military?
Yes
No
Branch & Final Rank:
High School
Name and Location
Graduate?
Yes
No
College/University
Name & Location
Graduate?
Yes
No
Diploma:
Trade School or Graduate School
Name and Location
Graduate?
Yes
No
Diploma:
List any scholastic honors, offices held and activities involved in during high school or college (You may exclude any that would disclose membership in a protected class):
List and describe any other school or specialized training relevant to the position applied for:
If currently employed, may we contact your present employer?
Yes
No
Have you ever been fired or asked to resign from a job?
Yes
No
If yes, explain:
If you have worked in any of your previous positions under another name, please give the name(s):
List employers with present or last employer, first. Account for all periods of time including any volunteer service or periods of unemployment. If self-employed, give the firm's name and supply business references:
Please give the following: Name of employer, address, dates of employment, job title, duties, beginning wage, ending wage, name and title of last supervisor, phone number, reason for leaving.
Please give three BUSINESS references (No relatives):
Provide name, phone number and occupation of each.
AFFIDAVIT
*
I CERTIFY THAT MY ANSWERS TO THE FOREGOING QUESTIONS ARE TRUE AND CORRECT WITHOUT MISREPRESENTATION AND/OR MISSIONS OF ANY KIND. I UNDERSTAND THAT IF EMPLOYED, ANY FALSE, MISLEADING OR INCORRECT STATEMENTS MADE ON THIS APPLICATION OR DURING ANY INTERVIEWS MAY BE GROUNDS FOR MY IMMEDIATE DISCHARGE. I HEREBY AUTHORIZE THE COMPANY TO CONTACT ANY COMPANY OR INDIVIDUAL IT DEEMS APPROPRIATE TO INVESTIGATE MY EMPLOYMENT HISTORY, CHARACTER AND QUALIFICATIONS. I GIVE MY CONSENT TO THEIR REVEALING ANY AND ALL INFORMATION AS A RESULT OF THIS INVESTIGATION.
Thank you!
H2318_WS17