Application For Employment Form
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1A
Beaver City Corporation, Beaver, Utah
pplication For Employment
with
We are an equal opportunity employer. We comply with all applicable Federal, State and Local laws concerning discrimination in employment.
No question in this applications is intended to elicit information in violation of any such law nor will any information obtained in response to any
question be used in violation on any such law.
PLEASE PRINT
Position(s) applied for______________________________________________ Date of Application_____/_____/_____
Name ___________________________________________________________________________________________
Last
First
Middle
Address _____________________________________________________________________P.O. Box _____________
Street
City
State
Zip
Phone _______________________ Mobile/Beeper/Other ______________________ Soc. Sec. No._________________
If you are under 18, and it is required, can you furnish a work permit?
Yes
No
If no, please explain _________________________________________________________________________________
Have you ever been employed here before?
Yes
No
Are you legally eligible for employment in this country?
Yes
No
Date you are available for work _____/_____/______
Type of employment desired
Full-Time
Part-Time
Temporary
Seasonal
Are you able to meet the attendance requirements for the position?
Yes
No
Have you been convicted of a crime in the last (7) years?
Yes
No
If yes, please explain __________________________________________________________________________
Are you willing to, and by signing this application give permission to, have a background check made on yourself?
Yes
No
Driver=s license number __________________________ Commercial Drivers license number ___________________
Do you hereby agree to a drug test and health physical as a condition of your employment? Yes
No
Professional or trade licenses, certificates or registrations you possess.
_______________________________________________________________________________________________
Typing Speed ___________ Education Level Grade School
High School Highest year completed _____________
College or Trade School Major or Subject Field ___________________ Degree or highest level _________________
Work Experience
List present and former employers beginning with the most recent
From________ To ________
Employer ___________________________
Phone ______________________
Job Title __________________
Address ____________________________
Contact Person _______________
Reason for
Summarize the nature of work performed and
Highest rate or salary
Leaving_________________________
job responsibilities.
_______________________________
_____________________________________
_____________________________________
From________ To ________
Employer ___________________________
Phone ______________________
Job Title __________________
Address ____________________________
Contact Person _______________
Reason for
Summarize the nature of work performed and
Highest rate or salary
Leaving_________________________
job responsibilities.
_______________________________
_____________________________________
_____________________________________
From________ To ________
Employer ___________________________
Phone ______________________
Job Title __________________
Address ____________________________
Contact Person _______________
Reason for
Summarize the nature of work performed and
Highest rate or salary
Leaving_________________________
job responsibilities.
_______________________________
_____________________________________
_____________________________________
I hereby certify that the above statements are true, and give permission for the background check and agree to a drug and health
physical as a condition of employment.
Signature __________________________________________ Date ______/______/______
ATTACH RESUME IF YOUR DESIRE
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Parent category: Business