|
First Name: |
|
|
Middle: |
|
|
Last Name: |
|
|
Address: |
|
|
City: |
|
|
State: |
|
|
Zip Code: |
|
|
Email: |
|
|
Home Phone: |
|
|
Mobile/Beeper: |
|
|
Position Applied For: |
|
Today's Date-mm/dd/yy:
|
|
Social Security #
|
|
If under 18, can you
furnish a work permit?
|
Yes
|
No |
|
|
|
|
|
|
|
If No, please explain: |
|
Have you ever been
employed here before? |
Yes
|
No |
If yes, position and date:
|
|
Are you legally eligible
for employment in this country?
|
Yes
|
No |
Date available for work (mm/dd/yy):
|
|
What is your desired salary range?($)
|
|
|
Type of employment desired: |
Full-Time
Part-Time
Temporary
Seasonal
Educational Co-op
|
Have you ever pled "guilty" or "no
contest" to, or been convicted of a crime?
|
Yes
|
No
|
If yes, please provide
date(s) and details: |
|
|
|
Employer 1:
|
|
|
Telephone #: |
|
|
Street Address: |
|
|
City: |
|
|
State: |
|
|
Starting job title/final job title: |
|
Immediate supervisor and title
(for most recent position held): |
|
|
Date of employment (from) mm/dd/yy: |
|
|
to (mm/dd/yy): |
|
|
Reason for leaving? |
|
What did you like most
about your position? |
|
Summarize any special training,
skills, licenses and/or certificates
that may assist you in performing the
position for which you are applying: |
|
| Employer
2: |
|
|
Telephone #: |
|
|
Street Address: |
|
|
City: |
|
|
State: |
|
|
Starting job title/final job title: |
|
Immediate supervisor and title
(for most recent position held): |
|
|
Date of employment (from) mm/dd/yy: |
|
|
to (mm/dd/yy): |
|
|
Reason for leaving? |
|
What did you like most
about your position? |
|
Summarize any special training,
skills, licenses and/or certificates
that may assist you in performing the
position for which you are applying: |
|
|
|
Computer Skills : |
Word Processing
Spreadsheet
Presentation
Email
Internet
|
|
Other: |
|
(Starting with your most recent
school attended, provide the following information.) |
|
School 1: |
|
|
Years Completed: |
|
|
Completed: |
Diploma
GED
Degree
Certificate
|
|
Other: |
|
|
Major/Minor: |
|
|
School 2: |
|
|
Years Completed: |
|
|
Completed: |
Diploma
GED
Degree
Certificate
|
|
Other: |
|
|
Major/Minor: |
|
List name and telephone number
of business/work references who are NOT related to you and are
NOT previous supervisors. If not applicable, list two school
or personal references who are NOT related to you. |
|
Name1: |
|
|
Title: |
|
|
Relationship: |
|
|
Telephone: |
|
|
Years known: |
|
|
Name2: |
|
|
Title: |
|
|
Relationship: |
|
|
Telephone: |
|
|
Years Known: |
|
|
By submitting this form, I certify
that all information I have provided to gain employment
with this employer is true, complete and correct.
I also understand that if I am hired, I will be required
to provide proof of identity and legal authorization to
work in the United States and that federal immigration laws
require me to complete an I-9 Form in this regard.
|
|
|