Employment Application
APPLICANT INFORMATION
Last Name Street Address City Phone Date Available Position Applied for Are you a citizen of the United States? Have you ever worked for this company? Have you ever been convicted of a felony? YES YES YES NO NO NO If no, are you authorized to work in the U.S.? If so, when? If yes, explain YES NO State E-mail Address Social Security No. Desired Salary First M.I. Date
Apartment/Unit # ZIP
EDUCATION
High School From College From Other From To Did you graduate? To Did you graduate? To Did you graduate? Address YES Address YES Address YES NO Degree NO Degree NO Degree
REFERENCES
Please list three professional references.
Full Name Company Address Full Name Company Address Full Name Company Address Relationship Phone ( ) Relationship Phone ( ) Relationship Phone ( )
PREVIOUS EMPLOYMENT
Company Address Job Title Responsibilities From To Reason for Leaving YES NO Phone Supervisor Starting Salary $ Ending Salary $ ( ) Starting Salary Phone Supervisor $ Ending Salary $ ( )
May we contact your previous supervisor for a reference? Company Address Job Title Responsibilities From To Reason for Leaving
May we contact your previous supervisor for a reference? Company Address Job Title Responsibilities From To Reason for Leaving
YES
NO Phone Supervisor ( )
Starting Salary
$
Ending Salary
$
May we contact your previous supervisor for a reference?
YES
NO
MILITARY SERVICE
Branch Rank at Discharge If other than honorable, explain From To
Type of Discharge
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. All employment is “at will” according to the current Pennsylvania labor laws. My employment can be terminated for any reason at any time. I hereby give approval for Glendorn to contact any of my past or previous employers to obtain work verification. I herby authorize any drug testing if Glendorn employers wish to administer for any reason. Signature Date