Preliminary Application for Employment

    Personal Information

    Present Address

    Are you 18 years or older?

    Employment Desired


    Grammar School

    High School


    Trade or Business

    Work History

    Show present and past employment including part-time employment. Note: If previously unemployed, give three (3) personal references over 21 years of age and their complete mailing address.

    Last Employer

    Next to Last Employer

    Second to Last Employer

    In Case of Emergency Notify:

    I certify that the fact contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

    I authorize investigation of all statements contained herein and the references listed to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you.

    I understand and agree that, if hired, my employment is for no definite period of time.