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APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
NAME
*
PRESENT ADDRESS
STREET ADDRESS
*
APT. NO.
*
CITY
*
STATE
*
ZIP
*
PERMANENT ADDRESS
STREET ADDRESS
*
APT. NO.
*
CITY
*
STATE
*
ZIP
*
ARE YOU 18 YEARS OR OLDER?
*
Yes
No
PHONE NUMBER
*
DESIRED EMPLOYMENT
POSITION
*
DESIRED LOCATION
*
DATE YOU CAN START
*
SALARY DESIRED
*
ARE YOU EMPLOYED NOW?
*
Yes
No
IF SO CAN WE CONTACT OF YOUR PRESENT EMPLOYER?
*
Yes
No
HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE?
*
Yes
No
WHERE?
*
WHEN?
*
HAVE YOU EVER WORKED FOR THIS COMPANY BEFORE?
*
Yes
No
WHERE?
*
WHEN?
*
REASON FOR LEAVING
*
NAME OF THE LAST SUPERVISOR OF THIS COMPANY
*
WHO REFERRED YOU TO THIS COMPANY?
*
EMPLOYMENT AGENCY
NEWSPAPER ADVERTISING
FRIEND
STATE EMPLOYMENT OFFICE
COLLEGE PLACEMENT SERVICE
ATLANTIC WIRELESS EMPLOYEE
Enter The Frien Name
Enter The Friend Location
OTHER
EDUCATION (Just Select The last Attended School)
SCHOOL LEVEL
*
NAME AND LOCATION OF SCHOOL
*
NO. OF YEARS ATTENDED
*
DID YOU GRADUATE?
*
SUBJECT STUDIED
*
College
High School
Grammar School
Yes
No
GENERAL
SUBJECTS OF SPECIAL STUDIES OR RESEARCH WORK
SPECIAL TRAINING
SPECIAL SKILLS
FORMER EMPLOYERS
LIST BELOW LAST THREE EMPLOYERS, STARTING WITH THE MOST RECENT
First Employer
*
NAME OF PRESENT OR LAST EMPLOYER
*
ADDRESS
*
CITY
*
STATE
*
ZIP
*
WEEKLY STARTING SALARY
*
WEEKLY FINAL SALARY
*
MAY WE CONTACT YOUR SUPERVISOR?
*
Yes
No
NAME OF SUPERVISOR
*
PHONE
*
DESCRIPTION OF YOUR WORK
*
Second Employer
NAME OF PRESENT OR LAST EMPLOYER
ADDRESS
CITY
STATE
ZIP
WEEKLY STARTING SALARY
WEEKLY FINAL SALARY
MAY WE CONTACT YOUR SUPERVISOR?
Yes
No
NAME OF SUPERVISOR
PHONE
DESCRIPTION OF YOUR WORK
Third Employer
NAME OF PRESENT OR LAST EMPLOYER
ADDRESS
CITY
STATE
ZIP
WEEKLY STARTING SALARY
WEEKLY FINAL SALARY
MAY WE CONTACT YOUR SUPERVISOR?
Yes
No
NAME OF SUPERVISOR
PHONE
DESCRIPTION OF YOUR WORK
REFERENCES
BELOW, GIVE THE NAME OF THREE PERSONS YOU ARE NOT RELATED TO, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
NAME
ADDRESS
BUSINESS
YEARS ACQUAINTED
1.
*
2. (Optional)
3. (Optional)
SERVICE RECORD
BRANCH OF SERVICE
DISCHARGE DATE RANK
HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST 5 YEARS?
*
Yes
No
IF YES EXPLAIN (WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION)
*
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.”
I AGREE
