Question? Call us at 207-563-3511 or email at general@mobiusinc.org

*
Mobius Inc. Job Application Form

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.



Fields marked with "*" sign are mandatory!



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PERSONAL INFORMATION




Applicant Name(*)

Please type your full name.

Present Address(*)

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Telephone Number(*)

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E-mail

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Permanent Address (If different from present address)

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Are you 18 years old or older? (*)

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Are you either a U.S. citizen or an alien authorized to work in the U.S.?

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Have you ever been arrested or convicted of a crime?(*)

Please fill in: Have you ever been convicted of a crime?

If yes, give details, including date(s)

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* A “yes” answer will not automatically disqualify you from employment. We will consider the nature and date of the offense and the job for which you are applying for job-related purposes only, and only to the extent permitted by applicable law.



POSITION DESIRED




Position/Type of Work(*)

Position(s) Applied For:

Date you can start(*)

Please Fill in: On what date would you be able to begin employment?

Salary Expectations(*)

Salary Expectations

Do you prefer(*)

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If part-time, hours per week desired

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Hours you are available to work

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Days of week you are available to work

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Are you interested in working with children? (*)

Please answer the question: Are you interested in working with children?

Are you able to work

Please fill in availability
You can select more than one.
Are you available to work overtime?(*)

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Have you previously worked for Mobius, Inc.?(*)

Have you ever been employed or filed an application with us before?

If yes please provide dates, position, reason for leaving

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How did you learn about this opening?

How did you learn about us?


EDUCATION




High School / GED (Required)(*)

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Graduated

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Course of Study

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Technical School

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Graduated

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Course of Study

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College/University

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Graduated

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Course of Study

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Other education or training

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Other special skills

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MILITARY EXPERIENCE




Branch of Service

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Dates Served

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Rank at Discharge

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Education and Training

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WORK EXPERIENCE





Please list all previous employment, beginning with the most recent. If you need more room, you may attach another sheet of paper.



Most Recent Employer


Employer:

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Address:

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Dates Employed (from - to):

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Position Held

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Reason for Leaving:

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Supervisor’s Name, Title, Phone and Contact Information

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May we contact?

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Description of Duties

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Second Recent Employer


Employer:

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Address:

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Dates Employed (from - to):

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Position Held

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Reason for Leaving:

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Supervisor’s Name, Title, Phone and Contact Information

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May we contact?

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Description of Duties

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Third Recent Employer


Employer:

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Address:

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Dates Employed (from - to):

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Position Held

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Reason for Leaving:

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Supervisor’s Name, Title, Phone and Contact Information

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May we contact?

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Description of Duties

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PERSONAL REFERENCES




First Reference Name:(*)

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First Reference Phone Number:(*)

Phone number must be in format (123-456-7890)

Second Reference Name:(*)

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Second Reference Phone Number:(*)

Phone number must be in format (123-456-7890)

Third Reference Name:(*)

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Third Reference Phone Number:(*)

Phone number must be in format (123-456-7890)


AUTHORIZATION AND ACKNOWLEDGMENTS





I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that if I am employed, any false statements on this application may be grounds for dismissal.

I authorize investigation of all statements contained in this application. I also grant permission to contact all references listed above, and authorize them to release all information concerning my previous employment and any other pertinent information these references might have, personal or otherwise. I release all parties from all liability for any damage that may result from furnishing this information to you.

I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time and without prior notice.




Today's Date


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I certify that the information provided in my Application of Employment is true:(*)

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