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Work With Us

General Information

Full Name(Required)

First

Date of Birth

MM slash DD slash YYYY

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone(Required)

Cell Phone

Email Address(Required)

Enter Email Confirm Email

Are you 18 years of age or older?(Required)

Yes

No

Are you a US Citizen?

Yes

No

Prefer Not To Say

Have you ever been convicted of a felony?

Yes

No

Prefer Not To Say

Are there any felony charges pending against you?

Yes

No

Prefer Not To Say

Please explain in detail. Note that a conviction does not mean you will not be offered a job.(Required)

Desired Employment

Position Being Applied For(Required)

Expected Pay Rate(Required)

Per(Required)

How did you hear of this position?(Required)

Specify Preferred Employment Status(Required)

Full Time

Part Time

Flexible / On Call

Date You Can Start Work(Required)

MM slash DD slash YYYY

Specify Days / Hours You Can Work

From(Required)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

To(Required)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

This field is hidden when viewing the form

Have You Worked or Applied With Us Before?(Required)

Yes

No

If yes, when?

MM slash DD slash YYYY

Why Are You Interested In Working For MAX?(Required)

Previous Employment History

Number of Jobs

Please enter a number from 0 to 3.

Job 1

Employer Name

Supervisor

Employer Address

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Starting Pay Rate

Ending Pay Rate

Title / Duties

Reason for Leaving

Job 2

Employer Name

Supervisor

Employer Address

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Starting Pay Rate

Ending Pay Rate

Title / Duties

Reason for Leaving

Job 3

Employer Name

Supervisor

Employer Address

Employment Start Date

MM slash DD slash YYYY

Employment End Date

MM slash DD slash YYYY

Starting Pay Rate

Ending Pay Rate

Title / Duties

Reason for Leaving

References

Name(Required)

Affiliation(Required)

Address(Required)

Phone(Required)

Education

Please list your education information.

Level (H.S., College, etc.)

School Name

City/State

Course of Study

Graduate? If yes, what year?

Supplemental Information

Please list all other training, certifications, skills, licenses, languages, internships, or other achievements that are applicable to the position for which you are applying. PLEASE NOTE IF YOU ARE BILINGUAL AND ABLE TO READ, WRITE AND SPEAK ENGLISH AND SPANISH.

Emergency Contact Information

Full Name(Required)

Relationship(Required)

Phone Number(Required)

Upload Application Files

Max. file size: 300 MB.

Cover Letter and Resume

Optional Information

Gender

Ethnicity

Are you an individual with a disability?

Yes

No

Prefer Not To Say

Did you serve in the United States Armed Forces?

Yes

No

Prefer Not To Say

Consent

APPLICANT’S CERTIFICATION AND AGREEMENT

171 Lincoln Ave. Suite 20
Holland, MI 49423
Phone: (616) 355-1010
Fax: (616) 928-2467
info@catchamax.org

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