Application for Employment Form

APPLICATION FOR EMPLOYMENT For Personnel use only Employment Form Last Name: _______________________ First: _________________ MI: ___ Date of Application: _________________ Street Address: ______________________________________ City:_________________State:_________ZIP:____________ Type(s) of Work Desired: _____________________________________________________ Social Security number:______________________________ Home telephone: _________________ Work telephone: _________________ How Were You Referred To Us? (Circle only one.) A By Your College B Advertisement C Employment Agency D By an Employee If So, Give Name: ________________________________ E Open house F Walk-in G Other Please Read Carefully And Complete By Printing In Ink Or Typing. An Equal Opportunity Employer We are an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose. Provide All Information Requested. Your complete application form will be maintained in our active files for six (6) months from the date of application. You may submit a new application at any time. EMPLOYMENT RECORD Starting with present or most recent, list all previous employers. Include self-employment and summer and part-time jobs. If more space is required, please continue on a separate sheet. You may attach a resume, but complete this application as well. Last Or Present Company: ____________________________________________________________________ Type of Business: ____________________________________________________________________ Type or Classification of Job: ____________________________________________________________________ Street Address:______________________________________ City:_________________State:_________ZIP:____________ Phone number:_________________ Brief Description of Job Duties: ____________________________________________________________________ Supervisor's Name:__________________________________ Phone number:_________________ Base salary:__________________ Dates worked: From___________ To____________ Reason for leaving: ____________________________________________________________________ Last or Present Company: ___________________________________________________ Type of Business: ___________________________________________________ Type or Classification of Job: ___________________________________________________ Street Address:______________________________________ City:_________________ State:_______ ZIP:____________ Phone number:_________________ Brief Description of Job Duties: ___________________________________________________ Supervisor's Name: ___________________________________________________ Phone number:_________________ Base salary:_________________ Dates worked: From _____________ To _______________ Reason for Leaving: ___________________________________________________ EDUCATIONAL HISTORY High School: School Name: _____________________________________________ Location (city, state): __________________________________ Major Course or Subject:__________________________________ Dates Attended: From _____________ To _______________ Graduated: Yes ____________ No ___________ Degree: __________________________________ Technical/Trade (after high school) School Name: _____________________________________________ Location (city, state): __________________________________ Major Course or Subject:__________________________________ Dates Attended: From _____________ To _______________ Graduated: Yes ____________ No ___________ Degree: __________________________________ College (list all attended) School Name: _____________________________________________ Location (city, state): __________________________________ Major Course or Subject:__________________________________ Dates Attended: From _____________ To _______________ Graduated: Yes ____________ No ___________ Degree: __________________________________ School Name: _____________________________________________ Location (city, state): __________________________________ Major Course or Subject:__________________________________ Dates Attended: From _____________ To _______________ Graduated: Yes ____________ No ___________ Degree: __________________________________ Other education/training School Name: _____________________________________________ Location (city, state): __________________________________ Major Course or Subject:__________________________________ Dates Attended: From _____________ To _______________ Graduated: Yes ____________ No ___________ Degree: __________________________________ School name: _____________________________________________ Location (city, state): __________________________________ Major Course or Subject:__________________________________ Dates Attended: From _____________ To _______________ Graduated: Yes ____________ No ___________ Degree: __________________________________ OUTSIDE ACTIVITIES (Exclude those indicating race, color, religion, sex, national origin, age, or handicap.) Professional memberships, certificates, or licenses held ___________________________________________________ ___________________________________________________ ___________________________________________________ Past and Present Civic or Cultural Activities (include offices held) ___________________________________________________ ___________________________________________________ Principal Hobbies ___________________________________________________ ___________________________________________________ SPECIAL SKILLS To be Completed by Applicant for Office/Clerical Work Typing: Yes____ Words per Minute: _________ No____ Dictation: Yes____ Words per minute: _________ No____ To be Completed By Applicant for Shop/Plant Work Type of Machines Operated: ___________________________________________________ ___________________________________________________ Years Experience: ________ Computer Skills Hardware: ___________________________________________________ Software: ___________________________________________________ Please list Other Skills and/or Equipment/Language Experience You Have Acquired: ___________________________________________________ ___________________________________________________ List Other Shop/Production Skills: ___________________________________________________ ___________________________________________________ Served Apprenticeship: Yes_______ Type: __________________________________ No_______ MILITARY RECORD Branch of Service ___________________________________________________ From _____________ To ____________ Present Military Affiliation: None____ Reserve (active)_____ Reserve (inactive)______ Kinds of Training and Duty While in Service: ___________________________________________________ ___________________________________________________ PROFESSIONAL/WORK REFERENCES List two past supervisors and one person who is not related to you who have knowledge of your qualifications for the position for which you are applying. Name: ___________________________________________________ Title/Relationship: _____________________________________ Street Address:______________________________________ City:_________________State:_________ZIP:____________ Phone no. (include area code)______________________ Occupation: _______________________________________ May We Contact Your Present Employer? Yes ________ No _________ Wage or Salary Required: _________________ Date Available: _________________ I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company's service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself. ___________________________________________________ Signature Date: _________________ If any of your educational or employment records are under other than the above name, please provide other names. ___________________________________________________ ___________________________________________________