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Middle Intial

Last Name *

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Address *

City *

State *

AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Zip

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Job Information

Position *

AV Installation Technician (Part-Time)

AV Production Technician

Other Future Position(s) (Please specify)

How did you hear about this job? *

Heartlandav.comFacebookLinkedInPersonal ConnectionOther

If Other, please specify

Do you have any personal connections with Heartland AV (Formerly Kucharo Sound)? *

Yes - Vendor

Yes - Customer

Yes - Employee

Yes - Other

No

If Yes, Please specify

Desired Locaton

Kansas City, MOWichita, KSOther

Desired Compensation? *

Other Information

Do you have a valid driver's license? *

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Driver's License Number

Do you have a commercial driver's license? *

Yes

No

Have you had any traffic violations in the past 5 years? *

Yes

No

If so, please list and explain each.

Do you have any criminal convictions? *

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If so, please list and explain each.

Current/Most Recent Employer

Start Date

End Date

Company Name

Title

Supervisor Name

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Are you currently employed by this company

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Reason for Leaving

Previous Employer

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Title

Supervisor Name

Supervisor Title

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Are you currently employed by this company

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Current/Ending Pay

Reason for Leaving

High School/GED

School Name *

City *

State *

AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Did you graduate from high school? *

Yes

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GED

Date Graduated

Post-Secondary Education #1

School Name

City

State

AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Did you graduate?

Yes

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Date Graduated

Post-Secondary Education #2

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City

State

AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Did you graduate?

Yes

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Date Graduated

Post-Secondary Education #3

School Name

City

State

AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Did you graduate?

Yes

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Date Graduated

Professional Reference #1

Name *

Relationship *

Title *

Company *

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Professional Reference #2

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Company

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Professional Reference #3

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