Safety Specialist

JP Cullen — Janesville, WI

Contact: Laura Cullen
Phone: 6085635411
E-mail: laura.cullen@jpcullen.com

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Personal Contact Information

First Name ^*

Last Name ^*

Email Address ^*

Birth Date ^*

Phone ^*

Mobile

Address ^*

City ^*

State ^*

Zip Code ^*

General Information

Date you can start work ^*

Salary Desired

Do you have a High School Diploma or GED? ^*
Yes
No

Are you authorized to work in the U.S. on an unrestricted basis? ^*
Yes
No

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) ^*
Yes
No

If yes, please explain

School History

School Name

Address/City/State

Degree

School Name

Address/City/State

Degree

School Name

Address/City/State

Degree

Work History

Current Employer:

Job Title

Start Date

End Date

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for Leaving

Starting Salary

Ending Salary

May we contact your present employer? ^*
Yes
No

Past Employers:

Job Title

Start Date

End Date

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for Leaving

Starting Salary

Ending Salary

Job Title

Start Date

End Date

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for Leaving

Starting Salary

Ending Salary

References

Name

Phone

Address/City/State

Relation

Name

Phone

Address/City/State

Relation

Name

Phone

Address/City/State

Relation

Resume

Upload Resume ^*

File types accepted: pdf,doc,docx,odt,txt
Files must be 2MB or less

Please read the following disclaimer:

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability.

JP Cullen offers reasonable accommodation in the employment process for individuals with disabilities. If you need assistance in the application or hiring process to accommodate a disability, you may request an accommodation at any time.

JP Cullen, in considering my application for employment, may verify the information set forth on this application and obtain additional background information relating to my background. I authorize all persons, schools, companies, corporations, credit bureaus, and law enforcement agencies to supply any information concerning my background.

I agree with the Terms and Conditions ^*

Signature (Print Full Name) ^*