NAME (LAST, FIRST):
SOCIAL SECURITY #:
DATE YOU CAN START:
ARE YOU EMPLOYED NOW?
IF SO, MAY WE INQUIRE WITH YOUR PRESENT EMPLOYER?
ARE YOU LEAGALLY AUTHORIZED TO WORK IN THE US?
EVER APPLIED TO THIS COMPANY BEFORE?
IF SO... FOR WHAT POSITION?
NAME & LOCATION OF SCHOOL
DID YOU GRADUATE?
TRADE, BUSINESS OR
SUBJECT OF SPECIAL STUDY / RESEARCH WORK
U.S MILITARYOR NAVAL SERVICE / RANK:
DATE / MONTH / YEAR
NAME / ADDRESS OF EMPLOYER
REASON FOR LEAVING
GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT
LEAST ONE YEAR.
"I certify that the facts contained in this application are true anb 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 and employers 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 the company from all
liability for any damage that may result from utilization of such information. I
also understand and agree that no representative of the company has any authority
to enter into any agreement for employment for any specified period of time, or
to make any agreement contrary to the foregoing, unless it is in writing and signed
by an authorized 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 federal and state laws."