Employment Application Application InformationKindly write "N/A" on fields that are not applicable.Application Date(Required) Name(Required) First Middle Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Date Available(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Position Applied For(Required) Do you have a TWIC card?(Required) Yes No Can you travel?(Required) Yes No Heights OK?(Required) Yes No Have you ever been Bonded?(Required) Yes No Have you ever been denied bonding?(Required) Yes No Are you a citizen of the United States?(Required) Yes No If no, are you authorized to work in the US?(Required) Yes No Have you ever worked for this company?(Required) Yes No If so, when?(Required) Have you ever been convicted of a felony?(Required) Yes No If yes, explain: Why do you believe that you are a good candidate for employment with Avian Flyaway, Inc?(Required)EducationHigh School(Required) High School Address(Required) High School Start:(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920High School End:(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Did you graduate High School?(Required) Yes No High School Degree Earned:(Required) ReferencesPlease list three professional references.First Reference Name(Required) First Last First Reference Company(Required) First Reference Relationship(Required) First Reference Phone(Required)First Reference Address(Required) Second Reference Name(Required) First Last Second Reference Company(Required) Second Reference Relationship(Required) Second Reference Phone(Required)Second Reference Address(Required) Previous EmploymentFirst Previous Employer Company Name(Required) First Previous Employer Phone(Required)First Previous Employer Address(Required) First Previous Employer Job Title(Required) First Previous Employer Starting Salary(Required) First Previous Employer Ending Salary(Required) First Previous Employer Responsibilities(Required) First Previous Employer Start Date(Required) First Previous Employer End Date(Required) First Previous Employer Reason for Leaving(Required) First Previous Employer Supervisor Name(Required) May we contact your First Previous supervisor for a reference?(Required) Yes No Second Previous Employer Company Name(Required) Second Previous Employer Phone(Required)Second Previous Employer Address(Required) Second Previous Employer Job Title(Required) Second Previous Employer Starting Salary(Required) Second Previous Employer Ending Salary(Required) Second Previous Employer Responsibilities(Required) Second Previous Employer Start Date(Required) Second Previous Employer End Date(Required) Second Previous Employer Reason for Leaving(Required) Second Previous Employer Supervisor Name(Required) May we contact your Second Previous supervisor for a reference?(Required) Yes No Military ServiceMilitary Service Branch Military Service Start Date Military Service End Date Military Service Rank at Discharge Military Service Type of Discharge If your Military Service Discharge is anything other than honorable, explain: Emergency Contact InformationEmergency Contact Name(Required) Emergency Contact Relationship(Required) Emergency Contact Address(Required) Emergency Contact Phone(Required)Disclaimer and SignatureConsent(Required) I authorize Avian Flyaway, Inc. to investigate all statements and information contained in the application, and I understand that any misrepresentation or omission of facts requested is cause for dismissal. I further understand that I may be expected to provide copies of diplomas, transcripts, certificates or licenses if needed.Signature(Required)Date Signed(Required) 60823
