First Name:
Last Name:
Social Security No.
Present Address
Apt NO.
City
State:
Zip
Permanent Address
Apt NO.
City
State:
Zip
Previous Address if less than 3 years
Previous Address
Apt NO.
City
State:
Zip
Are you 18 years of age
Type Yes or No.
Are you legally authorized to work in the US?
Type Yes or No.
Desired Employment
Position
Are you employed now?
Type Yes or No.
If so May we contact your present employer?
Type Yes or No.
Ever applied to this company before?
Type Yes or No.| When?
Where?
Ever worked for this company before?
Type Yes or No.| When?
Where?
Reason for leaving.
Name of last supervisor at this company.
High School
Name and location of high school.
Number of years attended.
Did you graduate?
Subjects studied..
Collage
Name and location of high school.
Number of years attended.
Did you graduate?
Subjects studied.
Trade,Business or Correspondence School.
Name and location of high school.
Number of years attended.
Did you graduate?
Subjuects studied.
General
Subjects of special study or research work.
Special training.
Special skills.
Former Employers
List Below last three employers, starting with most recent
Name of present or last employer.
Address.
City.
State.
Zip.
Starting Date.
Leaving Date.
Job title.
Weekly Starting Salary
Weekly Final Salary.
May we contact your supervisor
Type Yes or No.
Name of Supervisor.
Title
Phone
Description Of Work
Reason For Leaving
Name of present or last employer.
Address.
City.
State.
Zip.
Starting Date.
Leaving Date.
Job title.
Weekly Starting Salary
Weekly Final Salary.
May we contact your supervisor
Type Yes or No.
Name of Supervisor. .
Title
Phone
Description Of Work
Reason For Leaving
Name of present or last employer.
Address.
City.
State.
Zip.
Starting Date.
Leaving Date.
Job title.
Weekly Starting Salary
Weekly Final Salary.
May we contact your supervisor
Type Yes or No.
Name of Supervisor .
Title
Phone
Description Of Work
Reason For Leaving
References
BELOW GIVE THE NAMES OF THREE PERSONS YOU ARE NOT RELATED TO,WHOM YOU HAVE AT LEAST ONE YEAR.
1 Name.
Address.
Business
Years Acquainted
2.Name.
Address.
Business
Years Acquainted
3.Name.
Address.
Business
Years Acquainted
Have YOU EVER BEEN CONVICTED OF, PLED GUILTY/NO CONTEST TO,OR HAD A SUSPENDED IMPOSITION OF SENTENCE FOR ANY OFFENSE(OTHER THAT A MINOT TRAFFIC VIOLATION?) if yes, explain
(A CONVICTION RECORD WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION.THIS INFORORMATION WILL BE USED ONLY
FOR JOB-RELATED PURPOSOSES AND ONLY TO THE EXTENT PERMITTED BY LAW.)
AUTHORIZATION
"I CERTIFY THAT 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 CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OT OTHERWISE AND RELEASE THE COMPANT FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UNTILIZATION OF SUCH INFOR MATION.”
“ I ALSO INDERSTAND AND SPECIFIED PERIOD OF TIME,OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOIN,UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHIRIZED COMPANY REPRESENTATIVE.”
“THIS WAIVER DOES NOT PERMIT THE RELEASE OR USE OF DISABILITY-RELATED OR MEDICAL INFORMATION IN A MANNER PROHIBITED BY THE AMERICANS WITH DISABILITIES ACT (ADA) AND OTHER RELEVANT FEDERL AND STATE LAWS.”
BEFORE YOU SUMMIT THE APPLICATION YOU MUST READ OVER THE APPLICATION AND AGREE THE THE TERMS.
DATE:
I agree to the above terms
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