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Employment Application AN EQUAL OPPORTUNITY EMPLOYER
PERSONAL INFORMATION
NAME (LAST, FIRST):
SOCIAL SECURITY NO.:
PRESENT ADDRESS:
APT. NO.:
CITY:
STATE:
ZIP:
PERMANENT ADDRESS:
ARE YOU 18 YEARS OR OLDER?
YES NO
HOME PHONE:
CELL PHONE:
OTHER PHONE:
DESIRED EMPLOYMENT
POSITION DESIRED:
DATE YOU CAN START:
SALARY DESIRED:
ARE YOU EMPLOYED NOW?
IF SO MAY WE INQUIRE YOUR PRESENT EMPLOYER?
EVER APPLIED TO THIS COMPANY BEFORE?
WHAT LOCATION?
WHEN?
EVER WORKED FOR THIS COMPANY BEFORE?
REASON FOR LEAVING:
NAME OF LAST SUPERVISOR AT THIS COMPANY:
WHO REFERRED YOU TO THIS COMPANY? NEWSPAPER AD – REF: NO:
EMPLOYMENT AGENCY FRIEND (Friend’s Name)
STATE EMPLOYMENT AGENCY COLLEGE PLACEMENT SERVICE WALK-IN OTHER
EDUCATION
GRAMMAR SCHOOL
Y N
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL
GENERAL
SUBJECTS OF SPECIAL STUDY OR RESEARCH:
SPECIAL TRAINING:
SPECIAL SKILLS:
FORMER EMPLOYERS
LIST BELOW LAST THREE (3) EMPLOYERS, STARTING WITH THE MOST RECENT ONE FIRST.
NAME OF PRESENT OR LAST EMPLOYER:
ADDRESS:
JOB STARTING DATE:
JOB ENDING DATE:
JOB TITLE:
WEEKLY STARTING SALARY:
WEEKLY FINAL SALARY:
MAY WE CONTACT YOUR SUPERVISOR?
NAME OF SUPERVISOR:
TITLE:
PHONE:
DESCRIPTION OF WORK:
NAME OF LAST EMPLOYER:
REFERENCES
GIVE NAMES OF THREE PEOPLE BELOW THAT YOU ARE NOT RELATED TO AND YOU HAVE KNOW AT LEAST ONE YEAR.
NAME
ADDRESS
PHONE NUMBER
YEARS KNOWN
1
2
3
SERVICE RECORD
BRANCH OF SERVICE:
DISCHARGE DATE / RANK:
BACKGROUND
HAVE YOU BEEN CONVICTED:
a) IN THIS STATE OR ANY OTHER STATE, OF A FELONY? YES NO
IF YES, EXPLAIN (this will not necessarily exclude you from consideration)
b) IN THIS STATE OR ANY OTHER STATE, OF A MISDEMEANOR FOR THEFT OR A CRIME OF MORAL TURPITUDE? 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.
You acknowledge that by clicking on (I agree/understand) or similar button at the bottom of GILLC document you are indicating your intent to sign the relevant document or record and that this shall constitute as your signature. I have read, understand and have completed the application to the best of my knowledge. I also agree that the above facts contained in this application are true and correct.
You acknowledge that by clicking on (I agree/understand) or similar button at the bottom of GILLC document you are indicating your intent to sign the relevant document or record and that this shall constitute as your signature.
I have read, understand and have completed the application to the best of my knowledge. I also agree that the above facts contained in this application are true and correct.
By completing the information below you are indicating acceptance of electronic signature.
Print Name
Witness Print Name
Date