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Application for Employment
   
 
 

 PERSONAL HISTORY.

     Please provide the following contact information:

First name Middle
Last name
Street address
Address (cont.)
City
Zip/Postal code
Home Phone
E-mail
How Long have you lived there?
Do you have the legal right to live and work in the United States?      Yes No
Are you over 18 and under 70 years of age?      Yes No
Position applying for:
Full or Part Time? 
Are you a full time student?     Yes No
How did you learn of this position?
If employed, are you willing to accept prevailing wage for the job you are seeking?      Yes No
Willing to work Days?         Yes No
Willing to work Nights?       Yes No
Willing to work Sundays?    Yes No
If hired, do you have dependable means of transportation to work?     Yes No
Have you, since the age of 18, ever been convicted of a misdemeanor or felony?     Yes No
 
WORK HISTORY:
Start with Present or most recent employer:
Name of company
Address
Dates employed
Describe your job
Starting Rate
Last Rate
Supervisors Name
Phone number
Reason for Leaving

Previous Employer:        

Name of company
Address
Dates employed
Describe your job
Starting Rate
Last Rate
Supervisors Name
Phone number
Reason for Leaving

Previous Employer:

Name of company
Address
Dates employed
Describe your job
Starting Rate
Last Rate
Supervisors Name
Phone number
Reason for Leaving
MILITARY SERVICE RECORD:
Have you ever served in the U.S. Armed Forces? Yes    No
If Yes, Which Branch?............ .....
Dates of Duty............................... 
What was your Rank at discharge?
EDUCATIONAL HISTORY: List any and all education; include diploma and/or degree(s) earned.

    

Do you have any physical or mental conditions or disabilities which might, in any way, hinder your ability to perform the job which you applied? If yes, Please explain.

    

Have you had any recent or past illness or operations which might, in any way, hinder your ability to perform the job for which you applied? If yes, Please Explain

    

Have you had any recent or past injuries which might, in any way, hinder your ability to perform the job for which you have applied? If yes, Please Explain

    

     If offered employment, on what date are you available to start?.

    

     PART TIME ONLY: Indicate the Days and Hours available.

     MONDAY             TUESDAY

     WEDNESDAY   THURSDAY

     FRIDAY             SATURDAY

     SUNDAY        

     Additional Comments:

    

     I hereby certify that each of my answers to the foregoing is true and correct and I understand that the giving of false information ,either by omission or commission herein may subject me to immediate dismissal. I further agree to abide by the rules of Chanatry's if so employed and to conduct myself in a manner which will promote the safety of myself and my co-workers. I also understand that this application is not a contract and does not imply employee rights.

           I Agree       I Disagree

09/08/06 12:52 PM