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HOYA
Shamir
Contact
Welcome
Main
Who We Are
Products
Promotions
Product Offerings
Profit Builder
Optical Accelerator
Missing Products
Lens Availability
Varilux
Transitions
HOYA
Shamir
Contact
Job Application
Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Primary Phone #
*
(###)
###
####
Email
*
Date Available
*
MM
DD
YYYY
Social Security Number
*
Desired Salary
Position Applied For
Are you a citizen of the United States
*
Yes
No
If no, are you authorized to work in the U.S.?
Yes
No
Are you fluent in multiple languages?
*
Yes
No
If yes, what languages?
Have you ever worked for this company?
*
Yes
No
If yes, when?
Have you ever been convicted of a felony?
*
Yes
No
If yes, explain
How many days of work have you missed in the last 12 months?
*
Education
High School
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
From
MM
DD
YYYY
To
MM
DD
YYYY
Did you graduate?
Yes
No
College
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
From
MM
DD
YYYY
To
MM
DD
YYYY
Did you graduate?
Yes
No
Other
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
From
MM
DD
YYYY
To
MM
DD
YYYY
Did you graduate?
Yes
No
References
Reference 1
*
Relationship
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Reference 2
Relationship
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Reference 3
Relationship
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Previous Employment
Company
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Supervisor
*
Job Title
*
Starting Salary
*
Ending Salary
*
Responsibilities
*
From
*
MM
DD
YYYY
To
*
MM
DD
YYYY
Reason for Leaving
*
May we contact your previous supervisor for a reference?
*
Yes
No
Company
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM
DD
YYYY
To
MM
DD
YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Company
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM
DD
YYYY
To
MM
DD
YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
Yes
No
Military Service
Branch
From
MM
DD
YYYY
To
MM
DD
YYYY
Rank at Discharge
Type of Discharge
If other than honorable, explain:
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
*
Date
*
MM
DD
YYYY
Thank you!