The Delta Companies
 
 
 
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Contact Information
Resume  
Name (First, M, Last)  
Social Security:  
Street Address:  
City:  
State:  
ZipCode:  
Email Address:  
Primary Phone:  
Alternate Phone:  
Position Applying For:  
Earnings Expected:  
Referred By:  
     
Business Experience
Most Recent Employer:  
Complete Address:  
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Nature of Business:  
Dates of Employment:  
Initial Title/Position:  
Most Recent Title/Position:  
Initial Compensation:  
Final Compensation:  
Base:  
Bonus:  
Other:  
Immediate Supervisor
(Name, Title):
 
What did you like most about this job?  
What did you least enjoy?  
Reason for leaving?  
     
Education & Military Experience
High School:  
College/Graduate School:  
Degree:  
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Dates in Service:  
Highest Rank:  
Additional Information:  
     
Personal History
Publications, professional licenses, professional/job-related organizations, additional special honors or awards, etc.  
What qualifications, abilities, and strong points will help you succeed in this job?  
What are your weak points and areas for improvement?  
 
Other
Are you willing to relocate?  
In no, please explain:  
How often are you willing to travel overnight?  
What are your career objectives?  
Do you have the legal right to work in the United States?  
Have you ever been convicted of a crime (Other than traffic violations )  
If yes, please explain:    
   
Release of Information

By typing my name in the field below, I certify that answers given in this Employment Application are true, accurate and complete to the best of my knowledge. I authorize investigation into all statements I have made on this application as may be necessary for reaching an employment decision.

In the event I am employed, I understand that any false or misleading information I knowingly provided in my Employment Application or interview(s) may result in discharge and/or legal action. I understand also that if employed, I am required to abide by all rules and regulations of the employer and any special agreements reached between the employer and me.

I authorize The Delta Companies by its agents or representatives to consult with all individuals and organizations who may have information bearing on my current competence, character, and ethical qualifications.

I release from liability all representatives of The Delta Companies, and its employees, for their acts performed in good faith and without malice in connection with the evaluating of my credentials and qualifications.

I release from liability any and all individuals and organizations who provide information to The Delta Companies, and its physicians or employees, in good faith and without malice concerning my professional competence, specific training, experience, ethics, character, health and other qualifications and I consent to the release of such information.

 
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