APPLICATION FOR EMPLOYMENT 

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion, national origin, marital status, physical or mental handicap or arrest record. 

PERSONAL INFORMATION                    Date__________________ Social Security Number________________________

Name
______________________________________________________________________________________________
                           Last                                                     First                                           Middle

Present Address
______________________________________________________________________________________________
Phone Number ____________________________________
Are you legally entitled to work in the United States?                _________yes                 _________no

State the Name and Department of any relative, other than your spouse, already employed by the company:
__________________________________________________________________________________

Referred by:
__________________________________________________________________________________

EMPLOYMENT DESIRED:

Position _______________________________ Date you can start__________________ Salary desired ____________

Are you currently employed? ___________________ If so, may we inquire of your present employer? _______________
Have you ever applied to this company before? _________________ When? ______________Where? _____________

EDUCATION

Name and location of school                      Circle year completed               Did you graduate?          Subjects studied & degrees

Grammar School _____________________1   2   3   4___________________________________________________
High School _________________________1   2   3   4___________________________________________________
College _____________________________1   2   3   4___________________________________________________
Correspondence School ________________1   2   3   4___________________________________________________
Courses currently studying ________________________________________________________________________
Subjects of special study or research work, for whom, and when completed:____________________________________
_____________________________________________________________________________________________
Activities (Civic, athletic, etc.) in which you participate: ___________________________________________________
_____________________________________________________________________________________________
(EXCLUDE ORGANIZATIONS, THE NAME OR CHARACTER OF WHICH INDICATES THE RACE, RELIGION, CREED, COLOR, NATIONAL ORIGIN OR DISIBILITIES OF ITS MEMBERS.)

FORMER EMPLOYERS: (List below your last three employers, starting with the most recent.)

Date:   Month/Year                Name and Address of Employer                  Salary Position                      Reason for leaving
From ____________            ___________________________                ____________                   _________________
To     ____________            ___________________________                ____________                   _________________
May we contact them? _______yes         _______no

From ____________            ___________________________                ____________                   _________________
To     ____________            ___________________________                ____________                   _________________
May we contact them? _______yes         _______no

From ____________            ___________________________                ____________                   _________________
To     ____________            ___________________________                ____________                   _________________
May we contact them? _______yes         _______no
_____________________________________________________________________________________________

REFERENCES: (Give below the names of three persons NOT related to you, whom you have known for at least one year.)

             Name                                        Address                                            Business                              Years Acquainted    
1. ___________________________________________________________________________________________
2. ___________________________________________________________________________________________
3. ___________________________________________________________________________________________

I certify that the foregoing statements are true and correct. I authorize the company to make investigation of my personal or employment history and authorize any present/former employer, person, firm, corporation, credit agency or government agency to give to the Company any information they have regarding me, and I understand that any misrepresentation or omission shall be cause for dismissal. In consideration of the Company review of this application, I release the Company and all providers of information from any liability as a result of furnishing and receiving information.

I further agree that, if employed, I will conform my conduct to the Company’s rules, regulations and personnel policies. I understand that no personnel recruiter, interviewer or other representative other than an officer of the Company has authority to enter into any agreement for employment for any specified period of time and that any employment manuals or handbooks that may be distributed to me during the course of my employment shall not be construed as a contract. I further understand that nothing contained in this application or the granting of an interview creates a contract for either employment or providing any benefit, and THAT I HAVE THE RIGHT TO TERMINATE EMPLOYMENT AT ANY TIME AND THAT THE COMPANY HAS THE SAME RIGHT.

Date __________________                    Signature________________________________________