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First Name

Required
Middle Initial

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Last Name (*)

Required
Street Address

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E-mail (*)

Required
City

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State
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Zip Code

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Day Phone (*)

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Evening Phone

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How did you hear about Curbside?

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Have you ever applied with us before?
YesNo
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If yes, when/where

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Have you ever been employed by Curbside?
YesNo
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If yes, when/where

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EMPLOYMENT DATA

Position applying for

*REQUIRED
Location

REQUIRED
Salary Requirements

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Date Available for Work

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Total Hours Available Per Week

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Check hours you are interested in
Full-Time
Part-Time
Days
Nights
On-Call
Summer

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Enter the hours you can work each day


Sun

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Mon

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Tues

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Wed

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Thurs

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Fri

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Sat

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Can you operate a standard shift vehicle?
YesNo
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Do you have reliable transportation to/from work?
YesNo
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GENERAL INFORMATION

Are you 19 years of age or older?
YesNo
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(Required for insurance purposes)

Are you legally authorized to work in the United States?
YesNo
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Do you have a valid driver's license?
YesNo
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(If hired, you will be required to submit proof of your identify and legal work authorization as a condition of employment)

Driver's License Number

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State License Issued
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License Expiration Date

Required
Have you provided your driving record?
YesNo
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(Applicants must provide a driver's record as a condition of employment. Additionally, you will be required to sign a release form authorizing a criminal background check, which is attached).


SECURITY DATA

Read this carefully before answering the following questions: You may answer "No" if your criminal record consists of one or more of the following: (a) a sealed record on file with the commissioner of Probation, (b) a case of delinquency or a child in need of service which did not result in a complaint transferred to the Superior Court for criminal prosecution, (c) your crimes were misdemeanors and they occurred five or more years ago, or (d) your misdemeanors were limited to first offense for drunkenness, simple assault, speeding, minor traffic offenses, disturbance of the peace, or affray.

Have you ever been convicted of a felony, excluding misdemeanor?
YesNo
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If yes, give details including date, location (city and state), nature of offense and disposition

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NOTE: A conviction record will not necessarily be a bar of employment.


SPECIAL SKILLS/TRAINING

Please include any additional information that may be helpful to us in considering you for employment including licenses, equipment operated, computer skills, foreign languages, honors, awards, professional affiliations, technical training, etc.

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EDUCATION AND/OR MILITARY TRAINING


High School

Name

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City

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State
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Awarded Diploma or GED
YesNo
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Circle Highest Grade Completed in High School
9101112
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College Experience (years)
1234
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College Name or Military School

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Address

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Major

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Degree Obtained

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EMPLOYMENT

Please complete in detail starting with your most recent place of employment:

Present Employer

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End Date

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Start Date

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Street Address

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City, State, Zip Code

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Position Held

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Responsibilities

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Start Salary

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End Salary

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Supervisor

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Phone

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Reason For Leaving

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Previous Employer

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Start Date

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End Date

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Street Address

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City, State, Zip Code

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Position Held

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Responsibilities

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Start Salary

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End Salary

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Supervisor

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Phone

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Reason For Leaving

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May we contact your current employer(s) as a reference?
YesNo
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REFERENCE DATA

Please list additional references who have supervised you that can verify your work history and performance. Please do not include names of relatives.

Supervisor’s Name

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Phone Number

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Company Name and Address

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My Position While Employed

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Employed From

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To

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Supervisor’s Name

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Phone Number

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Company Name and Address

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My Position While Employed

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Employed From

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To

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Upload your resume.

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I accept the terms outlined below
Accept
Required

  

• I certify that all information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal, if hired.
• I authorize Curbside, Inc. to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment.
• I understand that I may be asked to provide consent for a criminal background check and that upon receiving a job offer, a physical examination and drug screening may be required. (If this is a job requirement, you will be notified).
• Regardless of whether or not I become employed by Curbside, Inc., I recognize that this application is not and should not be considered a contract of employment. I understand that employment at this company is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the company’s.