WE ARE AN EQUAL OPPORTUNITY EMPLOYMENT COMPANY. WE ARE DEDICATED TO A POLICY OF NON DISCRIMINATION IN EMPLOYMENT ON ANY BASIS INCLUDING RACE, CREED, COLOR, AGE, SEX, RELIGION, OR NATIONAL ORIGIN OR PHYSICAL HANDICAP.
(PLEASE PRINT) PERSONAL INFORMATION DATE NAME LAST FIRST MIDDLE PRESENT ADDRESS STREET CITY STATE ZIP PERMANENT ADDRESS STREET CITY STATE ZIP PHONE NO. SOCIAL SECURITY NUMBER REFERED BY:
EMPLOYMENT DESIRED POSITION DATE YOU
CAN START SALARY
DESIRED ARE YOU EMPLOYED NOW? IF SO, MAY WE INQUIRE
OF YOUR PRESENT EMPLOYER? EVER APPLIED TO THIS COMPANY BEFORE? YES NO DATE
EDUCATION NAME AND LOCATION OF SCHOOL YEARS ATTENDED GRADUATED SUBJECT STUDIED GRAMMAR SCHOOL
TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL
SUBJECT OF SPECIAL STUDY OR RESEARCH WORK
U.S. MILITARY OR
NAVAL SERVICE RANK PRESENT MEMBERSHIP IN
NATIONAL GUARD OR RESERVES ACTIVITIES OTHER THAN RELIGIOUS
(CIVIC, ATHLETIC, FRATERNAL, ETC) EXCLUDE ORGANIZATIONS, THE NAME OR CHARACTER OF WHICH INDICATES THE RACE, CREED, COLOR, OR NATIONAL ORIGIN OF IT’S MEMBERS. (CONTINUED ON OTHER SIDE)
FORMER EMPLOYERS: (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST) DATE
MONTH AND YEAR NAME AND ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING FROM TO FROM TO FROM TO FROM TO REFERENCES: (GIVE BELOW THE NAMES OF TWO PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR) NAME ADDRESS BUSINESS YEARS ACQUAINTED
I hereby authorize and request any and all of my former employers and any other person, firm, or corporation to furnish any and all information concerning my credit-worthiness and personal background and I hereby release each such employer or other person, firm, or corporation from any and all liability by reason of furnishing the requested information. I understand that in connection with this application, a consumer report and/or an investigative consumer report may be requested whereby information is obtained through personal interviews with my neighbors, friends, or associates or with others with whom I am acquainted or who my have knowledge with respect to my character, general reputation, personal characteristics and mode of living, and hereby authorize the procurement of any such report. I understand that, upon my request, I have the right to know if any such report was requested an, if so, the name and address of the consumer reporting agency that furnished such report and in the case of a consumer investigative report, that I may inspect and receive a copy of such report by contacting such agency. I also understand that I have the right to receive a complete and accurate disclosure of the nature and scope of the information requested if I request such disclosure within a reasonable period of time.
I understand that if employed: 1) any misrepresentation or omission of facts requested in this application is cause for dismissal; and 2) my employment is for no definite period and I may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.
DATE: SIGNATURE OF APPLICANT:
FOR OFFICE USE ONLY INTERVIEWED BY DATE REMARKS NEATNESS CHARACTER PERSONALITY ABILITY HIRED FOR DEPT. POSITION WILL REPORT SALARY
WAGES APPROVED 1. 2. 3. EMPLOYMENT MANAGER DEPT. HEAD GENERAL MANAGER IN CASE OF