Employment Desired:

Position:

Date You Can Start:    Salary Desired: $

Are you employed now?   Yes      No
If so, may we inquire with your present employer?   Yes      No
Have you ever applied for employment with this company before?   Yes      No
Where:   When:

Referred by:

Education:

Grammar School

Name of school:
Location of school:
Number of years attended:
Did you graduate?  Yes      No   
Subjects studied:

High School

Name of school:
Location of school:
Number of years attended:
Did you graduate?  Yes      No   
Subjects studied:

College

Name of school:
Location of school:
Number of years attended:
Did you graduate?  Yes      No   
Subjects studied:

Trade, Business or Correspondence School

Name of school:
Location of school:
Number of years attended:
Did you graduate?  Yes      No   
Subjects studied:

Note: Qualified applicants will be required to have a physical examination by a company-designated physician which will include testing for the presence of marijuana, cocaine, opiates, phencyclidine (PCP) and amphetamines.

General:

Subjects of special study or research work:

Special skills:

Activities (civic, athletic, etc.):

EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, SEX, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.

US Military or Naval Services:

Rank:
Present membership in National Guard or Reserves:

Former Employers:

List below the last three (3) employers, starting with the last one first.

1.
From (date):  To (date):
Name of Employer: 
Address of Employer:
Salary:   Position:
Reason for leaving:

2.
From (date):  To (date):
Name of Employer: 
Address of Employer:
Salary:   Position:
Reason for leaving:

3.
From (date):  To (date):
Name of Employer: 
Address of Employer:
Salary:   Position:
Reason for leaving:

Which of these jobs did you like the best?
What did you like best about the job?

References:

Give the names of three (3) persons not related to you, whom you have known at least one (1) year.

1.
Name:
Address:
Phone:
Business:
Number of years acquainted:

2.
Name:
Address:
Phone:
Business:
Number of years acquainted:

3.
Name:
Address:
Phone:
Business:
Number of years acquainted:

The following statement applies in Maryland and Massachusetts (fill in name of state).

It is unlawful in the state of to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Signature of applicant (type name here):

In case of emergency, notify
Name:   Phone:
Address:

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected and, if I am in consideration of employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representatives, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."

Signature of applicant (type name here):

Date:

COMPLETING THIS FORM IS VOLUNTARY AND IS
NOT A REQUIREMENT FOR EMPLOYMENT.