Certifications and Licenses

Capability / Reliability

Do you have the ability, with or without reasonable accommodations, to work overtime, if overtime is required by the job for which you are appling? ☐ Yes ☐ No

Yes
No
Yes
No
Yes
No
Yes
No
How many days of work or school have you missed in the last 2 years?
How many times have you been late for work or school in the last 2 years?

Will you be willing and able to report to work on time every day on a regular and consistent basis? ☐ Yes ☐ No

Yes
No
Yes
No

Special Skills

If yes, what is the words per minute?
If yes, please describe.
What languages do you speak fluently?
Have you operated any machinery or special equipment?

Do you type? ☐ Yes ☐ No If yes, what is the words per minute?

Yes
No

Have you had any computer or word processing experience or training?

☐ Yes ☐ No

Yes
No

If yes, please describe.

What languages do you speak fluently?

Have you operated any machinery or special equipment?