Date_________________ Social Security Number_____________________
Name__________________________________ Phone_________________
Address_______________________________________________________
Referred by___________________Position desired____________________
Date you can start______________Salary desired_____________________
Full time___________ Part-time___________ Temporary______________
Are you currently employed?______ If, so we may we inquire of your
present employer?_____ Where are you employed and how long?
___________________________________________________Years______
Have you been convicted of a crime in the past?_____Please explain:
_____________________________________________________________
Are you legally eligible for employment in this country?________________
US military or civil service______________Speak another language______
Are you presently in the National Guard or Reserves?__________________
High School____________________________________________________
College_______________________________________________________
Trade/ Business School__________________________________________
Typing Speed___________(This job requires adequate typing skills!)
School Activities________________________________________________
Will this present a problem with scheduling of work hours?______________
Give the names, addresses, and phone numbers of three persons not related
to you and that you have known at least for three years.
Years
1.__________________, ___________________, ____________ known___
2.__________________,___________________, _____________,________
3.__________________, __________________,______________,________
WORK EXPERIENCE
From:_________________To:____________________
Employer______________________________________ Rate of pay_______________________
Address ______________________________________
Phone __________________Reason for leaving________________________________________
Supervisor_____________________________________
What were your responsibilities?____________________________________________________
______________________________________________________________________________
*****************************************************************************************
From:_________________To:____________________
Employer_____________________________________ Rate of pay_________________________
Address ______________________________________
Phone __________________Reason for leaving_________________________________________
Supervisor_____________________________________
What were your responsibilities?_____________________________________________________
_______________________________________________________________________________
*****************************************************************************************
From:___________________To:____________________
Employer_____________________________________ Rate of pay______________________
Address ______________________________________
Phone __________________Reason for leaving_________________________________________
Supervisor_____________________________________
What were your responsibilities?_____________________________________________________
_______________________________________________________________________________
IN CASE OF AN EMERGENCY, CONTACT:________________________phone_____________
I authorize investigation of all statements in this application.
I understand omission of facts
or misrepresentation of facts called for is cause for dismissal.
I understand and agree that my
employment is for no definite period and may, regardless of the date
of payment of my wages,
may be terminated at any time without previous notice.
Date_______________________ Signature________________________________________