| Full Name: |
Date: |
Street Address:
|
Home Telephone:
( ) |
City, State, Zip:
|
Business Telephone:
( ) |
| Have you ever applied for
employment with us? Yes
o No
o |
Social Security #: |
| If yes, Month & Year |
Location |
Pay Expected: |
| Position Desired: |
| Apart from absence for
religious observance, are you available for full-time work?
Yes o
No o
|
|
Will you work overtime if asked? Yes
o No
o
|
|
Are you legally eligible for employment in the United States?
Yes
o No
o |
| When will you be available
to begin work? |
| Other special training or
skill (languages, machine operation, etc.: |
The information requested is needed for a legally
permissible reason, including, without limitation, national security
considerations, a legitimate occupational qualification on business
necessity. The Civil Rights Act of 1964 prohibits discrimination in
employment because of race, color, religion, sex or national origin,
Federal law also prohibits discrimination based on age, citizenship &
disability The laws of most Sates also prohibit some or all of the above
types of discrimination as well as some additional types such as
discrimination based upon ancestry, marital status & sexual preference.
Prospective employees will receive consideration without discrimination
because of race, creed, color, sex, age, national origin, handicap or
veteran status.
| Education
Provide dates (from - to) you attended school: |
| Elementary: |
High School: |
College: |
| Other: (give name & dates) |
| Are you a U.S. Citizen?
Yes o
No o
|
Are you a Vietnam veteran?
Yes o
No o
|
Are you over 18 years of
age? Yes
o No
o
If not, employment is subject to
verification of age. |
Sex: Male
o
Female o |
| Have you ever
been bonded? Yes
o No
o If "Yes", with what employers? |
| Have you been convicted of
a crime in the past ten years, excluding misdemeanors & summary
offenses, which has not been annulled, expunged or sealed by a
court? Yes o
No o If "Yes" describe in
full:
|
| How long at present address?
____Years |
How long at previous
address? ____Years |
| Previous address: |
| Marital Status:
Single o
Engaged o
Married o
Separated o
Divorced o
Widowed o
|
| Date of Marriage: |
Number of dependents
including yourself: |
Please give accurate, complete full-time employment record.
Start with your present or most recent employer: |
| Company Name: |
Telephone: ( ) |
| Address: |
Employed (month & year):
From:
To: |
| Name of Supervisor: |
Weekly pay:
Start:
Last: |
| State Job Title & Describe Your Work:
|
Reason for leaving:
|
| Company Name: |
Telephone: ( ) |
| Address: |
Employed (month & year):
From:
To: |
| Name of Supervisor: |
Weekly pay:
Start:
Last: |
| State Job Title & Describe Your Work:
|
Reason for leaving:
|
| Company Name: |
Telephone: ( ) |
| Address: |
Employed (month & year):
From:
To: |
| Name of Supervisor: |
Weekly pay:
Start:
Last: |
| State Job Title & Describe Your Work:
|
Reason for leaving:
|
| Company Name: |
Telephone: ( ) |
| Address: |
Employed (month & year):
From:
To: |
| Name of Supervisor: |
Weekly pay:
Start:
Last: |
| State Job Title & Describe Your Work:
|
Reason for leaving:
|
| We may contact the employers
listed above unless you indicate those you do not want us to
contact. |
| DO NOT CONTACT: |
Employer: |
Reason: |
| Military: |
Did you serve in the U.S. Armed Forces?
Yes o
No o
|
If "Yes" what Branch?
|
| Describe any training
received relevant to the position for which you are applying. |
|