Job Description Form

Personal Information

Last Name *

First Name *

Middle Name

Date

Present Address

Street

City *

State *

Zip Code

Permanent Address

Street

City *

State *

Zip Code *

Phone Number *

Are you 18 years or older?

Yes

No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

Yes

No

Employment Desired

Position

Date you can start

Desired Salary

Are you employed now?

Yes

No

Ever applied to this company before?

Yes

No

May we inquired of your present employer?

Yes

No

Where?

When?

Referred By

Education

Grammar School

Name and Location of school

Number of years attended

Did you graduate?

Yes

No

Subjects Studied

High School

Name and Location of school

Number of years attended

Did you graduate?

Yes

No

Subjects Studied

College

Name and Location of school

Number of years attended

Did you graduate?

Yes

No

Subjects Studied

Trade business or correspondence school

Name and Location of school

Number of years attended

Did you graduate?

Yes

No

Subjects Studied

General

Subjects of special study or research work

Special Skills

Activities: (Civic Athletic etc.)

EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.

U.S Military or Naval Service

Rank

Present Membership in National Guard or Reserves

Former Employers

Date / Month / Year

From

To

Name

Address

Salary

Position

Reason for Leaving

From

To

Name

Address

Salary

Position

Reason for Leaving

From

To

Name

Address

Salary

Position

Reason for Leaving

From

To

Name

Address

Salary

Position

Reason for Leaving

Which of these jobs did you like best?

What did you like most about this job?

References

Name

Address

Business

Years Acquainted

Name

Address

Business

Years Acquainted

Name

Address

Business

Years Acquainted

THE FOLLOWING STATEMENT APPLIES IN: MARYLAND & MASSACHUSETSS. (Fill in name of state.)

IT IS UNLAWFUL IN THE STATE OF TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLETS THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.

Applicant Name

In case of emergency notify

Name

Address

Phone Number

I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AN EMPLOYED. MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATION, AND I AGREE THAT MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND TAHT NO COMPANY REPRESENTATIVE, OTHER THAT IT'S PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

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