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Biographical Information: |
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Name: |
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Address: |
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City: |
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State: |
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Zip
Code: |
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Home
Phone: |
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Cell
Phone: |
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Are
you eligible to work in this country?:
Yes
No |
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Have
you ever been employed by this company?:
Yes
No |
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Position Desired: |
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Salary Desired: |
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Salary Rate: |
Per
Hour
Per
Week
Per
Year |
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How
were you referred to BCC? |
Advertisement
Employment
Agency |
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Self-Referral
Employee
Referral |
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Employee referral
name: |
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When
would you be able to work?: |
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Work
schedule desired?: |
Full-Time
Temporary
Part-Time
Summer
Only |
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Hours
available?: |
Days
Afternoon
Evenings |
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If
needed can you travel?: |
Yes
No |
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If
needed can you work extra hours?: |
Yes
No |
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Educational Background: |
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Name
of Institution: |
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High
School: |
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City/State: |
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College: |
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City/State: |
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College: |
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City/State: |
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Additional Education: |
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City/State: |
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Extracurricular activities or honors?: |
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Additional
Data: |
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List
skills or technical knowledge: |
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List
certificates, licenses, professional
associations or other pertinent info: |
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Typing speed (WPM) |
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Do
you have any physical limitations which may
limit you ability to perform the duties of the
position for which you are applying?: |
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Have
you been convicted of a felony within the last 7
years? |
Yes
No
If yes, explain:
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Personal
References:
Please do not use
relatives. |
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Name: |
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Address: |
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City: |
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State: |
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Relationship: |
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Years
known: |
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Phone
#: |
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Name: |
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Address: |
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City: |
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State: |
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Relationship: |
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Years
known: |
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Phone
#: |
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Name: |
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Address: |
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City: |
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State: |
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Relationship: |
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Years
known: |
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Phone
#: |
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Employment
History: Start with
current or most recent employer.
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Name
of Employer: |
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Address: |
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City: |
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State: |
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Zip
Code: |
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Position/Title: |
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Description of duties: |
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Significant accomplishments: |
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Starting Salary: |
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Ending Salary |
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Start
Date: |
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End
Date: |
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Reason for leaving: |
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Name
of Employer: |
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Address: |
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City: |
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State: |
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Zip
Code: |
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Position/Title: |
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Description of duties: |
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Significant accomplishments: |
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Starting Salary: |
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Ending Salary |
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Start
Date: |
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End
Date: |
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Reason for leaving: |
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Name
of Employer: |
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Address: |
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City: |
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State: |
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Zip
Code: |
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Position/Title: |
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Description of duties: |
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Significant accomplishments: |
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Starting Salary: |
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Ending Salary |
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Start
Date: |
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End
Date: |
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Reason for leaving: |
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Military
Experience: |
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Did
you serve?: |
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U.S.
Military Branch: |
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Active Duty Date: |
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Discharge Date: |
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Training/Specialty: |
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Application Agreement: |
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I
understand that any employment or offer of
employment arising out of this Employment
Application will be subjected to satisfactory
verification of the job qualifications which may
include academic credentials, licenses,
professional designations, and employment
history. I authorize this company to
contact any of my schools or former employers.
I authorize any former employer(s) to furnish
employment information, and I authorize any
former school(s) to furnish any academic
information. I release said employer(s)
and shool(s) and their agents from all liability
arising out of providing such information.
I
grant permission to this company to contact my
present employer:
PLEASE CHECK ONE:
Yes
No |
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I
also understand that employment with this
company is for no fixed period of time and may
be terminated by me or this company at any time
for any reason not specifically prohibited by
law, with or without notice. No oral
representation to the contrary has been made to
me, and I further understand that no employee of
this company is authorized to make any such
representation.
I
hereby certify that the information contained in
this Employment Application is true and
accurate. I understand that if I become
employed, any misrepresentation of facts on this
Employment Application is sufficient cause for
immediate dismissal.
By typing my name below, and clicking the submit
button, I agree to the above statements.
Type your name:
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