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XX  _    =  AccessLaPorteCounty(_ALCo_)  Kr=Ap_p_Ԁl_i_Ԁcat_i_ԀonforEmployment Kr |    (83"""  X?+4 44 <DL!X?   XB+` ` <DL!444XB} 2 3   `    }Allinformationobtainedwithinthisapplicationwillbeheldinstrictconfidence,subject  toapplicablelaw.݌ r  Ќ $ X` ` X$   ""  X?+4 44 <DL!X?   XB+` ` <DL!444XB} /2 3   `    }Pleasecompleteallapplicablesectionsandsignthelastpage./4݌ 1  Ќ $ X` ` X$   ""  X?+4 44 <DL!X?   XB+` ` <DL!444XB} R2 3   `    }Pleaseprintclearly.RW݌  M Ќ $ X` ` X$   ""  X?+4 44 <DL!X?   XB+` ` <DL!444XB} K 2 3   `    }Travelmayberequiredforcertainpositionsandavalidoperatordriverlicenseandor   passportmayberequireduponhire.K P ݌   Ќ $ X` ` X$    4    < X?+4 44 <DL!X?     ALCopridesitselfonbeinganEqualOpportunityEmployeranddrugfreework c  environment.Wewillnotdiscriminateinemploymentandorintheretainingof "  independentcontractingbecauseofsex,age,race,sexualorientation,physical   disability,religion,ethnicity,mentaldisability,maritalstatus,ancestry,orplaceof P  origin. _  N  XB+ 4 <DL!444XB 10 4   DateAY4) dE A: 4!4!  4 Name:  Telephone:(AY4) dE A߀)AY4)! dE! A I Address:AY4)" zdE" zA  AreyoulegallyentitledtoworkintheU.S.?AY4)FdEFA߀  (Proofwillberequireduponhire) E   Position(s)appliedfor:AY4)o +dEo +A  #  >#  Dateyouareavailableforemployment:AY4)i}dEi}A E Wageorsalarydesired:AY4) :dE :A s   2 EDUCATIONALBACKGROUND p !    ALCohasacompanypolicystatingaminimumeducationallevelofGrade12orequivalentforall !?" executiveandoradministrativepositions. "# sEDUCATIONALBACKGROUNDrelevanttothepositionappliedfor: ,$|% AY4)%dE%AHighestlevelofeducationcompleted:AY4)'dE'A ('x") Nameofeducational_institution:_ԀAY4)/)LdE/)LA (#+  4    <   Whatmachinesorequipmenthaveyouoperatedwhichrelatetothepositionyouhaveapplied $*t%- for? *3&. AY4)+dE+AArethereanyskills,experience,ofotherqualificationswhichyoufeelwouldassistyouin a,'0 performingthedutiesofthepositionyouhaveappliedfor?  -p(1 AY4).dE.A  -/)2   3a Ԁ&sQ% Listbelowyourlastthreeemployers,startingwiththemostrecent. o # %&sQi# EmployersName:  AY4) m>dE m>ACommencementDate:AY4)U  dEU A0 0< ! !0<!<!DepartureDate:0D!!AY4)c dEc A0D!D!0!!+ {!!  4    <   ReasonforDeparture:AY4)b l {dEb l {A   SupervisorsName:AY4)  dE A0 0< ! !0<!<!0!!Telephone:()AY4)& dE& A' w !!  4  Position(s)Held:0 0< ! !0<!<!0!! D Duties:  !! AY4) 9 dE 9 AAY4)> dE> A 4    <      D Maywecontactthisemployer?(Ifnot,statebriefreason): 2   4    <   AY4)sS dEsS A   D   3b  `   EmployersName:AY4) m>dE *>A# #    4   CommencementDate:0 0< ! !0<!<!DepartureDate:0D!!AY4)b # dEb AAY4)c dEc AAY4)c dEcA# # 0D!D!0!!l!!  4    <   ReasonforDeparture:AY4)b l {dEb l {A# C!# AY4) adE aA Y SupervisorsName:AY4)  dE AAY4)  dE cA# `"# 0 0< ! !0<!<!0!!Telephone:()AY4)& dE& A߀AY4)& dEcA# ## '!!  4  Position(s)Held:AY4) 9 dE 9 A# $# 0 0< ! !0<!<!0!! D Duties:AY4)> dE> A# %# U!! AY4) 9 dE 9 AAY4)> dE> A 4    <      D Maywecontactthisemployer?(Ifnot,statebriefreason):AY4)sS dE_S A# b&#  #  4    <      D AY4)sS dEsS A 4   # (# 3c  `   EmployersName:AY4) m>dE >A# /)#  N " CommencementDate:0 0< ! !0<!<!DepartureDate:0D!!AY4)b # dEb X"AAY4)c dEc AAY4)b # dEb X"A# )# AY4)b # dEb X"A# d+# AY4)b # dEb X"A# +# ԀAY4)c dEcX"A# j,# 0D!D!0!!!$!!  4    <   ReasonforDeparture:AY4)b l {dEb l {A߀AY4) adE #aA# ,# Ԁ J#& SupervisorsName:AY4)  dE AAY4)  dE T%A# L.# 0 0< ! !0<!<!0!!Telephone:()AY4)& dE& AAY4)& dET%A# =/# $ (!!  4  Position(s)Held:AY4) 9 dE &9 A# b0# 0 0< ! !0<!<!0!! D Duties:AY4)> dE&> A# /1# ԀF&!*!! AY4) 9 dE 9 AAY4)> dE> A 4    <      D Maywecontactthisemployer?(Ifnot,statebriefreason):AY4)sS dEP(S A# 2# Ԁ '#,  4    <      D AY4)sS dEsS A    # 3#  Pleaselistatleasttwo(2)PersonalReferencesandtelephone#(otherthanfamily B)$. members) *Q%/ AY4) adE ~+aA +&1  AY4) adE -aA  -\(4  -*)6   4# =6#0 4 Ifyouareapplyingforapositionthatrequiresdriving,pleasecompletethis o section:>4!4!  Doyouhaveavaliddriverslicense?AY4)r dEr A0  0!!0D!!License#:AY4)b dEb AlD!D!    50 4  Falseinformationgivenorimpliedonanapplicationformisgroundsforimmediate   dismissalandorvoidingofcontractwithoutfurthernotice.( x4!4!  Iherebystatethatallinformationprovidedisaccurateandmaybeverifiedbyyou.IagreethatI    maybedischargedandorhavemycontractvoidedifALCoatanytimelearnsoffalsificationor e  materialomissionintheinformationprovidedonthisapplicationformandrelateddocuments. $t  ALComaycontactmyformeremployerinconnectionwiththeconsiderationofthisapplication 3  withthem.Allreferencesareherebyauthorizedtoreleaseallinformationwhichtheymayhave   relevanttomyemploymentwiththem.IherebyreleaseALCo,itsaffiliates,successors,and a  assigns,andallreferencesfromanyliabilitythatmightbeclaimedbecauseofinformation  p  providedbysuchreferences.IagreethatIwillfollowall_ALCo_Ԁpolicies,rules,procedures,andall / otherdirectionspertainingtomyservicewiththem.IunderstandthatALCoreservestherightto  add,change,and/ordeleteanypolicies,procedures,workrules,and/orbenefitsatanytime. ] ApplicantSignature:AY4) m>dE &>A  Date:AY4)bdEbA h  NOCONSIDERATIONOFEMPLOYMENTWILLBEGIVENTOANYAPPLICANTWHODOES U NOTSIGNTHEABOVESTATEMENT. Note :Additionalpersonalinformationmayberequiredto d completeanyapplicableformsandordocumentspertainingtomyhire. #    XBX Thankyouforshowinganinterestinpursuingaposition " withAccessLaPorteCounty(ALCo) .  t # # XXB?#?