Initial Employment Form

APPLICANT INFORMATION

First Name*:

Last Name*:

Address*:

City*:

State*:

Zip*:

Phone*:

Email*:

Date Available*:
 

Position Desired*:

Have You Ever Worked For This Company*:
---NoYes

If Yes, When:

Have You Ever Been Convicted Of A Felony Or Misdemeanor*:
---NoYes

If Yes, Explain:

EDUCATION

High School:

From:

To:

Did You Graduate:
---NoYes

If Yes, Degree:

College:

From:

To:

Did You Graduate:
---NoYes

If Yes, Degree:

Other:

From:

To:

Did You Graduate:
NoYes

If Yes, Degree:

REFERENCES

Reference Name 1*:

Company*:

Phone*:

Relationship*:

Reference Name 2*:

Company*:

Phone*:

Relationship*:

Reference Name 3*:

Company*:

Phone*:

Relationship*:

PREVIOUS EMPLOYMENT

Employer 1:

Phone:

Supervisor:

May We Contact Your Employer:
---NoYes

Job Title:

Duties:

From:

To:

Reason For Leaving:

Starting Salary:

Ending Salary:

Employer 2:

Phone:

Supervisor:

May We Contact Your Employer:
---NoYes

Job Title:

Duties:

From:

To:

Reason For Leaving:

Starting Salary:

Ending Salary:

Employer 3:

Phone:

Supervisor:

May We Contact Your Employer:
---NoYes

Job Title:

Duties:

From:

To:

Reason For Leaving:

Starting Salary:

Ending Salary:

MILITARY SERVICE

Branch:

From:

To:

Rank At Discharge:

Type Of Discharge:

If Other Than Honorable, Explain:

FEEDBACK

How Did You Hear About The Opening*: ---RadioMerchandiser NewspaperLebanon Daily NewspaperPatriot News NewspaperPaxton Herald NewspaperOther NewspaperPA Career LinkGlennsTowing.comOther Internet Site

Will You Authorize Criminal & Driving Record Checks*: ---NoYes

Comments: