This document is an employment application that collects personal and job-related information from applicants. It requests contact details, education history, employment history including past positions and salaries, availability, and professional references. The applicant is asked to disclose any prior felony convictions and sign to acknowledge the truth and completeness of the application, with notice that false information could result in dismissal.

1. Employment Application 2008-2009
Personal Data
Name_____________________________________
Date______________________________________
Permanent Address_________________________
Phone Number______________________________
Social Security No____________________________
Job Interest
Position Applied For_____________________________________
Indicate Availability To Work: Full Time/Part Time/Days/Evenings
Available To Start_______________________
Referral Source__________________________________
Have you ever been employed by us before: Yes/No
Are you legally permitted to work in this country: Yes/No
Are you above the minimum working age of _______: Yes/No
Have you ever been convicted of a felony: Yes/No
If yes please
explain__________________________________________________________________
Education
Type Name and Location Courses Taken Graduated
High School
College
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University

2. Employment Application 2008-2009
Business, Trade,
Technical
Other
Employment History
(List previous employers beginning with most recent)
Company Name______________________________________________________________
Business Type_______________________________________________________________
Address____________________________________________________________________
Supervisor _________________________________________________________________
Supervisor
Title__________________________________________________________________
Position____________________________________________ Full Time/Part
Time/Temporary
Employment Dates (mm/yy):From __ __/__ __To__ __/__ __
Ending Salary:_________________
Reason for Leaving:____________________________________ May we contact: Yes/No
Company Name_______________________________________________________________
Business Type_________________________________________________________________
Address______________________________________________________________________
Supervisor
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_____________________________________________________________________

3. Employment Application 2008-2009
Supervisor
Title__________________________________________________________________
Position____________________________________________ Full Time/Part
Time/Temporary
Employment Dates (mm/yy):From __ __/__ __To__ __/__ __
Ending Salary:_________________
Reason for Leaving:___________________________________ May we contact: Yes/No
Company Name________________________________________________________________
Business
Type__________________________________________________________________
Address______________________________________________________________________
Supervisor___________________________________________________________________
Supervisor
Title__________________________________________________________________
Position____________________________________________ Full Time/Part
Time/Temporary
Employment Dates (mm/yy):From __ __/__ __To__ __/__ __
Ending Salary:___________________
Reason for Leaving:______________________________________ May we contact: Yes/No
Company Name________________________________________________________________
Business Type_________________________________________________________________
Address______________________________________________________________________
Supervisor____________________________________________________________________
Supervisor Title________________________________________________________________
Position____________________________________________ Full Time/Part
Time/Temporary
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4. Employment Application 2008-2009
Employment Dates (mm/yy):From __ __/__ __To__ __/__ __
Ending Salary:__________________
Reason for Leaving:___________________________________ May we contact: Yes/No
Professional References
(Please list three professional references below
Name Company and Title Business Telephone Home Telephone
I declare that the facts set forth in my application are true and complete.I understand that if I
am employed, false information stated in this application shall be sufficient cause for
dismissal.
Applicant Signature:____________________________________________________________
Date:___________________________
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