211 Porter Ave, Buffalo, NY 14201  (716) 881-9936

Employment

employment
Today's Date:*
Social Security Number-*
Present Address-*
Phone:*
-
Name (Last Name, First)*
Permanent Address*
E-mail:*
Referred By

Employment Desired

Position*
Are You Employed Now*
Ever Applied To This Company Before?*
Date You Can Start*
If So May We Inquire Your Current Employer*
Where
Salary Desired*
Are You Legally Authorized To Work In The U.S.*
When

Education History

High School*
Years Attended*
Did You Graduate?*
Subject Studied*
College
Years Attended-
Did You Graduate?.
Subject Studied.
Trade, Business, or Correspondence School
Years Attended-(1)
Did You Graduate?.(1)
Subject Studied.(1)
General Information
Subject of Special Study/Research Work
Special Training
Special Skills
Rank

Former Employers ( List the last four employers, starting with the last one first)

Date- Month & Year*
-
Position.*
Name & Address of Employer*
Salary*
Date- Month & Year(2)*
-
Salary(2)*
Name & Address of Employer(2)*
Position.(2)*
Date- Month & Year(3)*
-
Salary(3)*
Name & Address of Employer(3)*
Position.(3)*
Date- Month & Year(4)*
-
Salary(4)*
Name & Address of Employer(4)*
Position.(4)*

References (List below the names of three persons, not related to you, whom you have known for at least a year)

Name*
Phone.:*
-
Address*
Years Known*
Name(2)*
Phone.:(2)*
-
Address(2)*
Years Known(2)*
Name(3)*
Phone.:(3)*
-
Address(3)*
Years Known(3)*

"I certify that the facts contained in this application are true and complete to theĀ  best of my knowledge and understand that, if employed, falsified statements on this application will 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 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 or state laws."

Date:
Siganture