Employment Application – Personal

    Name

    Present Address

    How many years have you lived at this address?
    Telephone No. () -

    Previous Address

    Job(s) Applied For
    1. Rate of pay expected $ per
    2. Rate of pay expected $ per
    3. Rate of pay expected $ per

    Do you want to work Specific days & hours if part time:

    Have you worked for us before? If yes, when?

    List all relatives and/or close friends employed by the company

    If hired, on what date will you be available to start work?

    Do you have any prior work experience which you feel would help you if you were hired by the company?

    Education

    Type of School Name and Address Years Attended Graduated? Course or Major
    Grammar or Grade
    High School
    College
    Post Graduate
    Business or Trade
    Other

    Person to be notified in case of accident or emergency

    Name & relationship to you
    Address
    Phone number

    Personal references

    Name and occupation Address Phone No.

    Prior Work History

    List in Order, Last or present employer first

    From To Employer Name and Address Starting Pay Ending Pay Supervisor Reason for leaving
    Describe in detail the work that you performed
    		 May we contact this employer
    From To Employer Name and Address Starting Pay Ending Pay Supervisor Reason for leaving
    Describe in detail the work that you performed
    		 May we contact this employer
    From To Employer Name and Address Starting Pay Ending Pay Supervisor Reason for leaving
    Describe in detail the work that you performed
    		 May we contact this employer
    From To Employer Name and Address Starting Pay Ending Pay Supervisor Reason for leaving
    Describe in detail the work that you performed
    		 May we contact this employer
    From To Employer Name and Address Starting Pay Ending Pay Supervisor Reason for leaving
    Describe in detail the work that you performed
    		 May we contact this employer

    Unemployment Record

    You must account for all periods of unemployment in the last five (5) years.
    List all lost time in excess of 30 days

    From To Reason

    I UNDERSTAND THAT THIS IS AN APPLICATION AND NOT A CONTRACT OR UNILATERAL OFFER TO ENTER INTO A CONTRACT OF ANY KIND BETWEEN THE UNDERSIGNED AND THE EMPLOYER. THE USE OF THIS APPLICATION FORM DOES NOT INDICATE THAT THERE ARE ANY POSITIONS OPEN AND DOES NOT IN ANY WAY OBLIGATE THIS EMPLOYER.

    I UNDERSTAND THAT EMPLOYMENT IS CONDITIONAL UPON, AND I AUTHORIZE YOU TO MAKE SUCH INVESTIGATIONS AND INQUIRE OF MY PERSONAL, EMPLOYMENT, FINANCIAL AND OTHER LEGALLY RELATED MATTERS AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. I HEREBY RELEASE EMPLOYERS, SCHOOLS, OR PERSONS FROM ANY AND ALL LIABILITIES IN RESPONDING TO INQUIRIES IN CONEECTION WITH MY APPLICATION.

    I HEREBY CERTIFY THAT ALL OF THE INFORMATION I HAVE GIVEN ON THIS APPLICATION IS TRUE AND COMPLETE, AND THAT THERE ARE NO FALSE STATEMENTS OR OMISSIONS CONTAINED IN MY RESPONSE TO THE QUESTIONS IN THIS APPLICATION. I UNDERSTAND THAT ANY FALSE INFORMATION OR OMMISSIONS, WHETHER MADE OR OMITTED INTENTIONALLY OR WRITTEN AND LATER DISCOVERED, MAY BE CAUSE FOR REFUSAL TO HIRE ME OR FOR IMMEDIATE DISMISSAL WITHOUT FURTHER NOTICE.

    THIS APPLICATION IS CURRENT FOR ONLY SIXTY (60) DAYS. AT THE CONCLUSION OF THIS TIME, IF I HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, IT WILL BE NECESSARY FOR ME TO FILL OUT A NEW APPLICATION.