APPLICATION FOR EMPLOYMENT

Instructions: Complete all the necessary information.  You may be asked to provide additional information on another form.  This application will be kept on file.  Be sure to read and agree to the statement at the bottom of this page.

SECTION I - Personal Information

 

Miscellaneous
	If you are under 18, can you provide proof of your eligibility to work?	Yes No
	If yes, give date
	Have you ever been employed by our company?	Yes No
	If yes, give date
	Reason for leaving?
	Names of any relatives employed by this company
	Are you currently employed?	Yes No
	If not, how long since your last employment?
	May we contact your present employer?	Yes No
	Are you prevented from lawfully becoming employed in this country because of Visa? (Proof of citizenship will be required upon employment)	Yes No
	On what date will you be available for work?
	What are you able to work?	Full Time Shift Work	Part Time Temporary
	Are you currently on 'Layoff Status' and subject to recall?	Yes No
	Can you travel if the job requires it?	Yes No
	Have you ever been bonded?	Yes No
	If so, name of the bonding company?
	Have you been convicted of a felony within the last 7 years? (Conviction will not necessarily disqualify an applicant from employment)	Yes No
	If yes, please explain
	Are you capable of performing in a reasonable manner, with or without a reasonable accommodation?  The activities involved in the job or occupation for which you have applied?	Yes No

SECTION II - Educational Information
 

Education		Name&Address	Course	Years	Diploma Degree
	Elementary
	High School
	Undergraduate College
	Graduate Professional
	Other

 

Languages		Fluent	Good	Fair
	Speak
	Read
	Write

 

Additional
	State any additional information you feel may be helpful in considering your application
	Do not answer this question unless you have been informed about the requirements for the job in which you are applying

SECTION III - Employment Experience
Start with your present or last job.  Include any job-related military service assignments and volunteer activities.  You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities, or other protected status.  If you need additional space to provide supplemental information, please write it on last page of this application.  If this application is completed on-line, simply type the information on the last page of this application.

 

Past Employers
	Employer #1
	Complete Address
	Telephone
	Job Title
	Supervisor
	Dates Employed	to
	Starting and Finishing Hourly Rate/Salary	,
	Reason for leaving?
	Work Performed
	Employer #2
	Complete Address
	Telephone
	Job Title
	Supervisor
	Dates Employed	to
	Starting and Finishing Hourly Rate/Salary	,
	Reason for leaving?
	Work Performed
	Employer #3
	Complete Address
	Telephone
	Job Title
	Supervisor
	Dates Employed	to
	Starting and Finishing Hourly Rate/Salary	,
	Reason for leaving?
	Work Performed
	Employer #4
	Complete Address
	Telephone
	Job Title
	Supervisor
	Dates Employed	to
	Starting and Finishing Hourly Rate/Salary	,
	Reason for leaving?
	Work Performed

SECTION IV - References and Additional Information
 

References
	Name #1
	Complete Address
	Telephone
	Name #2
	Complete Address
	Telephone
	Name #3
	Complete Address
	Telephone
	Name #4
	Complete Address
	Telephone

 

Additional Information or Comments
	Add any additional information here, that you believe will be helpful. You may be asked to provide hard copies of additional information, such as your resume or Employee Data Cards.

SECTION V - Submit

The applicant must read and agree with the following text.  After reading, check the box at the bottom and press the submit button.  Your application will be delivered to George Brazil Services.