|
APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
Date:
Name (Last Name First):
SS#:
Present Address:
City:
State:
Zip Code:
Permanent Address:
City:
State:
Zip Code:
Phone #:
Referred by:
EMPLOYMENT DESIRED
Position: Date
you can start:
Hourly/Salary Wages Desired:
Full Time:
Part Time:
Either:
Are you employed?:
If so, may we inquire of your present
employer?
Ever applied to this company
before?: Where?:
When?:
EDUCATION HISTORY
GENERAL INFORMATION
Subjects of special
study/research work or special training.
FORMER EMPLOYERS
(List below last four
employers, starting with last one first)
REFERENCES
Give below the names of
three persons not related to you, whom you have know at least one
year.
Authorization
"I certify that
the facts contained in this 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 to 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, unless it is in
writing and signed by an authorized company representative.
This waiver does not
permit the release or use of disability-related or medical information
in a manner prohibited by the Americans with Disabilities Act (ADA)
and other relevant federal and state laws."
|