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1
APPLICATION FOR EMPLOYMENT
Personal
Date
Name(Last Name First)
Social Security Number
Present Address
City
State
Zip
Permanent Address
City
State
Zip
Phone Number
Referred By
ARE YOU 18 YEARS OF AGE OR OVER ?
Employment Desired
Position
Date You Can Start
Salary Desired
Are You Employed
IF SO, MAY WE CONTACT YOUR PRESENT OR PREVIOUS EMPLOYER
Below please check days and nights available.
Day
Day
Day
Day
Day
Day
Day
Day
Night
GENERAL
NAME AND LOCATION OF SCHOOL
YEARS ATTENDED
DID YOU GRADUATE
SUBJECT STUDIED
Grammar School
High School
Trade, Business OR Correspondence School
SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL TRAINING/SKILLS
0 /
US Military Or Naval Service
Rank
FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS STARTING WITH LAST ONE FIRST)
Date Month & Year
Name & Phone Number
Salary
Position
Reason For Leaving
From
To
Name
Salary
Position
Reason
From
To
Name
Salary
Position
Reason
From
To
Name
Salary
Position
Reason
Refrences
BELOW GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOME YOU HAVE KNOWN AT LEAST ONE YEAR
Name
Address
Business
Years Known
Name
Address
Business
Years Known
Name
Address
Business
Years Known
AUTHORIZATION

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE ANDCOMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED,FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.


I AUTHORIZED INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THEREFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATIONCONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEYMAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE THE COMPANY FROM ALL LIABILITYFOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION.


I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANYHAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANYSPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THEFOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANYREPRESENTATIVE.

Date
Signature
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