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APPLICATION FOR EMPLOYMENT
Date:
Personal Information
Present Address
Phone Number
Referred by
EMPLOYMENT DESIRED
Are you employed at present If so, may we inquire of your present employer?
EDUCATION Name and Location of School Years Attended Date Graduated Subjects Studied

Grammar School

High School

College
Trade, Business or Corres. School
PHYSICAL RECORDS:
Do you have any physical defects that preclude you from performing any work for which you are being considered?
Were you ever injured? Give details:
Have you any defects in hearing? In Vision? In Speech?
FORMER EMPLOYERS (List below last four employers, starting with last one first)
Date Month
Year
Name and address
of Employer
Salary Position Reason
for leaving
From
To
From
To
From
To
From
To
Do you have a valid Driver’s License? YES NO
Is your license a commercial Driver’s License? YES NO
If yes, what endorsements do you have?
Has your Driver’s License ever been revoked? YES NO
If yes, why?
Will you travel if necessary? YES NO
Do you have any other source of income that would conflict with this job? YES NO
May we verify the information that you have given us? YES NO
Do you have an AGC Craftworker Certification? YES NO
Union Member? YES NO
If yes, what is your local number?
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REFERENCES:
Give below the names of three persons not related to you, whom you have known at least one year.
Name Address Business Years Known
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND/OR SALARY, BE TERMIATED AT ANY TIME WITHOUT ANY PREVIOUS NOTICE.
Date: Signature: