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Employment Application
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Date
Position Applied For
Date of Birth
Phone
Current Address
How Long
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Rate of Pay Expected
Employment History
1) Name
Date
Address
Position Held
Contact Person
Phone
Reason for Leaving
Salary/Wages
2) Name
Date
Address
Position Held
Phone
Reason for Leaving
Salary/Wages
3) Name
Date
Address
Position Held
Phone
Reason for Leaving
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Additional Information
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To be read and signed by the applicant:
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if a conditional offer to employment has been extended.) I hereby release employers, schools, healthcare providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand also, that I am required to abide by all rules and regulations of the company.
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