Application Form
Application Form
Date Available: Are you currently employed? If "YES": Company Name: Address: City: Work days and time REFERENCES
[DATE] Yes No
State:
Work phones:
Please give below the names and addresses of people to whom we may apply for information about your work, experience and attendance record and indicate your relationship. One of them must be your most recent or current employer (if previously employed). If you have just left college, you may supply details of your Head Teacher/Principal. 1 Most recent employer Name: Address: ZIP: Phone: Fax: Email: Can we contact? Yes No 2 Relationship: Name: Address: ZIP: Phone: Fax: Email: Can we contact? Yes No 3 Relationship: Name: Address: ZIP: Phone: Fax: Email: Can we contact? Yes No
I certify that the above information (and any further information enclosed) is correct and I agree that the Employer may take reasonable steps to verify this information (e.g. by obtaining proof of qualifications). I agree to the Employer processing and retaining the personal information contained on this form for any purposes connected with my application. Signed
We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, colour, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment depends solely on your qualifications.