Application for Employment Application for Employment Name * Last * First Middle Address * Phone * Email * Date of Birth * Social Security Number * License Type * Class A Class B Other Driver/Chauffeur License * Position Desired * Date you would be available for work? * Do you have reliable transportation available? * If you are currently employed, may we contact your employer? * Describe any physical limitations, disease, or other disability, which should be regarded in assigning you work. * List any special skills or abilities you possess which would be beneficial to the position you are seeking. * Have you ever been discharged or forced to resign from any job? * Yes No If yes, explain: List and describe all traffic violations for which you have been cited during the past four years. * Have you been convicted of any violation of the law, excluding traffic violations? * Yes No If yes, explain: EDUCATION: Elementary Name of School Address Years Completed High School Name of School Address Years Completed College/University Name of School Address Years Completed Trade or Other Name of School Address Years Completed Additional education, if applicable Name of School Address Years Completed PAST EMPLOYMENT, starting with most recent Employer Address Phone From/To Duties/Responsibilities and Reason for Leaving Employer Address Phone From/To Duties/Responsibilities and Reason for Leaving Employer Address Phone From/To Duties/Responsibilities and Reason for Leaving Employer Address Phone From/To Duties/Responsibilities and Reason for Leaving Employer Address Phone From/To Duties/Responsibilities and Reason for Leaving Employer Address Phone From/To Duties/Responsibilities and Reason for Leaving Employer Address Phone From/To Duties/Responsibilities and Reason for Leaving Military Service Yes No Branch Discharge Date Discharge Type Are you now in the Reserve or National Guard Unit? Yes No REFERENCES: (Give the name of three people not related to you, whom you have known at least one year.) Name * Address * Business * Phone * Years Acquainted * Name * Address * Business * Phone * Years Acquainted * Name * Address * Business * Phone * Years Acquainted * IN CASE OF EMERGENCY NOTIFY: Name * Address * Phone * "I CERTIFY THAT THE 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 CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU. I UNDERSTAND AND AGREE THAT, IF HIRED MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE." * I HAVE READ, UNDERSTAND AND AGREE WITH THE ABOVE STATEMENT(S) reCAPTCHA Email Email Submit
