APPLICATION FOR EMPLOYMENT

 

LAWS ENACTED BY THE FEDERAL GOVERNMENT AND BY MANY STATES PROHIBIT JOB DESCRIMINATION BASED UPON RACE, RELIGION, COLOR, NATIONAL ORIGIN, SEX, AGE, DISABILITY OR MARITAL STATUS, UNLESS BASED UPON A BONAFIDE OCCUPATIONAL REQUIREMENT OR OTHER EXCEPTION.

 

Name Social Security No.
Present address
How long have you lived at above address? Phone Number
Previous address
How long did you live there?
Position (s) applied for
Were you previously employed by us? Yes No If yes, when?
List any friends or relatives working for us.
If your application is considered favorable, on what date will you be available for work?
Person to be notified in case of accident or emergency:
Name-relationship Address
Phone #    
Do you have any physical limitations? Yes No If yes, please describe
EDUCATION
Circle last year completed
Elementary School 5 6 7 8
High School 1 2 3 4
College 1 2 3 4
Describe any other training or education
LIST LAST 3 EMPLOYERS BEGINNING WITH YOUR MOST RECENT
Name of Company And type of business From Mo /Yr To Mo/Yr Describe in detail the work you did Rate of Pay Reason For Leaving Name of Supervisor
May we contact the employers listed above?
If not, indicate by number which one (s) you do not wish us to contact.
Have you received Workers Compensation for any injuries? If yes describe:
Have you been convicted of a crime in the past ten years? If yes, describe in full
ANSWER IN AS MUCH DETAIL AS POSSIBLE:
What equipment, if any, can you operate? (List your experiences with each)
Can you do any mechanical work? If so, explain
Are there any experiences, skills, or qualifications, which you feel would especially fit you for work with our Company?
The facts set forth above in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. You are hereby authorized to make any Investigation of my personal history and financial and credit record through any investigative or credit agencies or bureaus of your choice.