Employment Application

EMPLOYEE APPLICATION

GENERAL INFORMATION

First Name *requiredLast Name *requiredSSNAddressCity *requiredState *requiredZip CodePhone *required

previous employment

EmployerEmployment datesReasonfor leavingSupervisor nameZip Code

EMPLOYMENT VERIFICATION

Employed From - To (Ex. 2018-2020)DepartmentPositionSupervisor

Could you please rate the employee on a scale of 1 to 10 for the following traits, 10 being the best:

Reliable (dependable)Punctual (showed up for work on time, etc.)Trustworthy (honest)Job Skills (accomplished of assigned job)What did you like about this employeeDid you notice any problems or weaknesses which might cause difficulties in the new job?Would you re-hire this employee?Any other comments?

REFERENCES
(Name 3 persons other than relatives, former eployers, or persons whose identity might reveal or suggest religious or ethic affiliation. Include address and phone numbers.)

Reference #1Address #1Phone #1Reference #2Address #2Phone #2Reference #3Address #3Phone #3What kind of work can you do?Do you have a reliable transportation?HAVE YOU EVER BEEN CONVICTED OF A CRIME OTHER THAN MINOR TRAFFIC VIOLATIONSIf yes, explain fully. A criminal conviction will not necessarily be
a bar to employment. Any relevant factors such at age at time of offense, seriousness and nature of the violation, and rehabilitation will be taken into account.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THE ATTACHED APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL.

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EMPLOYEE APPLICATION