Application for Employment

Name  
Present Address,
City, State & Zip Code
Telephone #  
Soc. Sec. #

How long at Present Address? years
 months
Previous Address, City, State & Zip Code  
Do you have the legal right to work in the US permanently?
(yes or no)

 

 If no, explain:

Position Applied For:
Company Applied to: Dandy
 Williams Oil
 Williams Auto
Salary Desired:
Can you Work:

(Check all that apply)

 Nights
 Full Time
 HolidaysPart Time		 Saturdays
Sundays
Overtime
How soon could you start work?
Are you over the age of 18? Yes         If No, state age.
Do you have any impairments, physical, mental or medical, which would interfere with your ability to perform in your position(s) applied for?
Specify Highest Grade Completed: Grade School:
High School:
College:
Other:

  School Name Address City/State Graduate (Yes/No) Type of Degree Major Subjects
(High School)
(College)
(Other)  
Are you taking any courses now?   If "Yes", specify:
Employed By: Company/Address From: Mo/Yr. To: Mo/Yr. Pay Rate: Position Held: Reasons for Leaving: Supervisor:
1.  
     
 
2.  
     
             
3.  
     
May we contact your present or most recent employer?
May we contact your previous employers?

US Military Status Record
Present Draft Status:

 Present Reserve Status: 
(Check if Applicable)
None
Active
Inactive
Nat. Guard
Standby
Former Military Service Branch:
From Mo/Yr.     To Mo/Yr.
Highest Rank Held:
Service Schools Attended:
Primary Job In:
Rank at Discharge:
 

By submitting this application, I certify:
That this application is complete and accurate to the best of my knowledge and that I have not made any attempt to conceal information, and that falsification could be cause for dismissal. Also, I agree, if required, to undergo a medical examination by a company designated physician, and I understand that medical approval must be obtained before employment can be affected. I have noted that the company is an Equal Opportunity Employer, and all applicants will receive consideration for employment without regard to Race, Religion, Color, Sex, Age, Marital Status, National Origin, Disability or Conviction Record.