APPLICATION FOR EMPLOYMENT

3800 South Ocean Drive, uite #209, Hollywood, FL 33019

PERSONAL INFORMATION

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POSITION

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EDUCATION INFORMATION

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LICENSURE INFORMATION

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EMPLOYMENT HISTORY/JOB EXPERIENCE (Required!)

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EMPLOYMENT REFERENCES (give names of 3 employers)

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DESIRED SALARY PROPOSAL (Required! This is negotiable. Salary is based on knowledge of job, productivity, and accuracy of work performed.)

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ATTESTATION

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****PLEASE READ CAREFULLY AND SIGN BELOW****

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for a definite period that may be terminated at any time without previous notice regardless of the date of payment of my wages and salary.

Please check this box if you want to proceed.