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Name *

Name

First Name

Last Name

Social Security No. *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address *

Phone *

Phone

(###)

###

####

Referred by:

Employment Desired

Position

Date you can start *

Salary Desired

Are you employed? *

If so, may we inquire of your present employer? *

Ever applied to this company before? *

If so, Where/When?

Education History

Select last grade completed *

Name of High School attended

Address of High School attended

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Did you graduate?

Name of College or University attended

Address of College or University attended

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Subjects studied:

Did you graduate?

General Information

Subjects of special study/research, work or special training/skills

U.S. Military or Naval Service | Rank

Employment History (Starting with last one first)

Previous Employer 1:

Dates Employed:

Address of Previous Employer 1:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name and Title of Supervisor:

List job held, duties performed, and promotions gained while employed at this company

Reason for leaving:

Previous Employer 2:

Dates Employed:

Address of Previous Employer 2:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name and Title of Supervisor:

List job held, duties performed, and promotions gained while employed at this company:

Reason for leaving:

Previous Employer 3:

Address of Previous Employer 3:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name and Title of Supervisor:

List job held, duties performed, and promotions gained while employed at this company:

Reason for leaving:

References: Give below the names of three persons not related to you, whom you have known at least one year.

Reference 1:

Address of Reference 1:

Business:

Years known:

Reference 2:

Address of Reference 2:

Business:

Years known:

Date of application: *

Signature: (type name in box) *

Authorization:

"I certify the facts contained in this application are true and 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."

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Serving the Tri-Lakes area since 1978

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