Employment

PERSONAL INFO: all fields required

Full Name:

Present Address:

Phone Number:

Your Email:

EMPLOYMENT DESIRED: all fields required

Position:

Desired Hourly Wage:

Date You Can Start:

Are you currently employed?

Can we inquire with your present employer?

Have you ever inquired to this company before?

EDUCATION HISTORY

Please include: a). Name & Location of School, b). Years Attended, and c). Graduate?

High School:

College:

Trade, Business, or Correspondence School:

FORMER EMPLOYERS

Company | Supervisor | Phone #

Dates: From | To

Wage:

Reason for Leaving:

Company | Supervisor | Phone #

Dates: From | To

Wage:

Reason for Leaving:

Company | Supervisor | Phone #

Dates: From | To

Wage:

Reason for Leaving:

GENERAL INFO

Other trade skills (i.e., carpentry, plastering, drywall, etc.):

U.S. Military or Naval Service:

Rank:

REFERENCES

Give below the names of three persons, not related to you, whom you have known at least one year. They may be personal contacts or previous employers:

Name

Phone #

Business

Years Known

Name

Phone #

Business

Years Known

Name

Phone #

Business

Years Known

AUTHORIZATION

“I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws.”

Initials: