Job Application

Name

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Personal

Which position are you applying for?*

Name

First Middle Last Suffix

Permanent Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Email*

Are you over 18 years old?*

Yes
No

Other name(s) under which you have been previously employed

Names of friends or relatives employed in this organization

Have you ever applied to this organization before?*

Yes
No

If Yes, give date and position applied for

Have you ever been employed by this organization before?*

Yes
No

If yes, list dates of employment

Do you have any family, business, health, or social restrictions or obligations that would prevent you from performing the job responsibilities?*

Yes
No

Do you have any physical or mental condition or disability which would endanger the health or safety of yourself and or others or that may affect your ability to perform the job(s) for which you are applying?*

Yes
No

If yes, please describe such condition or handicap.

Will you comply with the safety work and attendance policies of our organization?*

Yes
No

Employment Interests

Date Available*

Type of Employment You Are Seeking:*

Full Time
Part Time
Temporary

Can you work overtime, including weekends as needed?*

Yes
No

How will you get to work?*

How were you referred to our organization?*

Name of Referral Source:

Education/U.S. Military Service

Where did you attend high school & college? (Click the + button to add a new row)*

School Name & Address	Major	Years Completed	GPA	Degree/Diploma

Are you taking any educational course(s) presently?*

Yes
No
I will be soon

If Yes or you will be soon, what and where?

Have you ever served in the U.S. Armed Services?

Yes
No

US Military Duties and special training

Rank held at discharge

References

List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)

Name	Address	Occupation	Years Known

Employment History

Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work.

Company Name (Most Recent)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Did you have another job before this one?*

Yes
No

Company Name (Second Most Recent)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Would you like to list another previous job?

Yes
No

Company Name (Third Most Recent)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Would you like to list a 4th job?

Yes
No

Company Name (Fourth Most Recent)

Address

Street Address Address Line 2 City State ZIP Code

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Do you hold any professional licenses or memberships?*

Yes
No

Professional Licenses & Memberships

You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.

I agree to a Drug Screening at the company's expense.*

Yes
No

I agree to a Criminal Background Check at the company's expense.*

Yes
No

Acknowledgement

Legal Terms of Service

Consent*

I agree to the privacy policy.

The Regeneration Project, LLC (“us”, “we”, or “our”) operates the https://www.regeneration-project.net website (the “Service”).
This page informs you of our policies regarding the collection, use, and disclosure of personal data when you use our Service and the choices you have associated with that data.
We use your data to provide and improve the Service. By using the Service, you agree to the collection and use of information in accordance with this policy. Unless otherwise defined in this Privacy Policy, terms used in this Privacy Policy have the same meanings as in our Terms and Conditions, accessible from https://www.regeneration-project.net
Information Collection And Use
We collect several different types of information for various purposes to provide and improve our Service to you.
Types of Data Collected
Personal Data
While using our Service, we may ask you to provide us with certain personally identifiable information that can be used to contact or identify you (“Personal Data”). Personally identifiable information may include, but is not limited to:
Email address
First name and last name
Phone number
Address, State, Province, ZIP/Postal code, City
Cookies and Usage Data
Usage Data
We may also collect information how the Service is accessed and used (“Usage Data”). This Usage Data may include information such as your computer’s Internet Protocol address (e.g. IP address), browser type, browser version, the pages of our Service that you visit, the time and date of your visit, the time spent on those pages, unique device identifiers and other diagnostic data.
Tracking & Cookies Data
We use cookies and similar tracking technologies to track the activity on our Service and hold certain information.
Cookies are files with small amount of data which may include an anonymous unique identifier. Cookies are sent to your browser from a website and stored on your device. Tracking technologies also used are beacons, tags, and scripts to collect and track information and to improve and analyze our Service.
You can instruct your browser to refuse all cookies or to indicate when a cookie is being sent. However, if you do not accept cookies, you may not be able to use some portions of our Service.
Examples of Cookies we use:
Session Cookies. We use Session Cookies to operate our Service.
Preference Cookies. We use Preference Cookies to remember your preferences and various settings.
Security Cookies. We use Security Cookies for security purposes.
Use of Data
The Regeneration Project, LLCuses the collected data for various purposes:
To provide and maintain the Service
To notify you about changes to our Service
To allow you to participate in interactive features of our Service when you choose to do so
To provide customer care and support
To provide analysis or valuable information so that we can improve the Service
To monitor the usage of the Service
To detect, prevent and address technical issues
Transfer Of Data
Your information, including Personal Data, may be transferred to — and maintained on — computers located outside of your state, province, country or other governmental jurisdiction where the data protection laws may differ than those from your jurisdiction.
If you are located outside United States and choose to provide information to us, please note that we transfer the data, including Personal Data, to United States and process it there.
Your consent to this Privacy Policy followed by your submission of such information represents your agreement to that transfer.
The Regeneration Project, LLCwill take all steps reasonably necessary to ensure that your data is treated securely and in accordance with this Privacy Policy and no transfer of your Personal Data will take place to an organization or a country unless there are adequate controls in place including the security of your data and other personal information.
Disclosure Of Data
Legal Requirements
The Regeneration Project, LLC may disclose your Personal Data in the good faith belief that such action is necessary to:
To comply with a legal obligation
To protect and defend the rights or property of The Regeneration Project, LLC
To prevent or investigate possible wrongdoing in connection with the Service
To protect the personal safety of users of the Service or the public
To protect against legal liability
Security Of Data
The security of your data is important to us, but remember that no method of transmission over the Internet, or method of electronic storage is 100% secure. While we strive to use commercially acceptable means to protect your Personal Data, we cannot guarantee its absolute security.
Service Providers
We may employ third party companies and individuals to facilitate our Service (“Service Providers”), to provide the Service on our behalf, to perform Service-related services or to assist us in analyzing how our Service is used.
These third parties have access to your Personal Data only to perform these tasks on our behalf and are obligated not to disclose or use it for any other purpose.
Analytics
We may use third-party Service Providers to monitor and analyze the use of our Service.
Google AnalyticsGoogle Analytics is a web analytics service offered by Google that tracks and reports website traffic. Google uses the data collected to track and monitor the use of our Service. This data is shared with other Google services. Google may use the collected data to contextualize and personalize the ads of its own advertising network.You can opt-out of having made your activity on the Service available to Google Analytics by installing the Google Analytics opt-out browser add-on. The add-on prevents the Google Analytics JavaScript (ga.js, analytics.js, and dc.js) from sharing information with Google Analytics about visits activity.For more information on the privacy practices of Google, please visit the Google Privacy & Terms web page: https://policies.google.com/privacy?hl=en
Links To Other Sites
Our Service may contain links to other sites that are not operated by us. If you click on a third party link, you will be directed to that third party’s site. We strongly advise you to review the Privacy Policy of every site you visit.
We have no control over and assume no responsibility for the content, privacy policies or practices of any third party sites or services.
Children’s Privacy
Our Service does not address anyone under the age of 18 (“Children”).
We do not knowingly collect personally identifiable information from anyone under the age of 18. If you are a parent or guardian and you are aware that your Children has provided us with Personal Data, please contact us. If we become aware that we have collected Personal Data from children without verification of parental consent, we take steps to remove that information from our servers.
Changes To This Privacy Policy
We may update our Privacy Policy from time to time. We will notify you of any changes by posting the new Privacy Policy on this page.
We will let you know via email and/or a prominent notice on our Service, prior to the change becoming effective and update the “effective date” at the top of this Privacy Policy.

Signature*

Date

Resume Upload (optional)*

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Cover Letter (optional)

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Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.

Personal

Employment Interests

Education/U.S. Military Service

References

Employment History

Acknowledgement

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