Application For Employment Page 4
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4Employment History and References
I __________________________________________ consent to New World Albany seeking verbal or
written information on a confidential basis about me, from representatives of my previous employers
and/or referees, and authorise the information sought to be released by them to New World Albany for
the purposes of ascertaining my suitability for the position for which I am applying. I understand that
the information received by New World Albany, is supplied in confidence as evaluative material and
will not be disclosed to me.
Signature ________________________________________
Date: ___ / ___ / _____
Present or Most Recent Employer
Company
Company address
Reference name
Their position or
job title
Contact Phone
Their relationship
Number
to you
Your Position / Job
Your length of
Title
service there
Reason for
leaving
Next Most Recent Employer
Company
Company address
Reference name
Their position or
job title
Contact Phone
Their relationship
Number
to you
Your Position / Job
Your length of
Title
service there
Reason for
leaving
Personal Referee
Name:
Relationship to you
Contact Address
Contact Phone Number
* If possible please include a land line rather than a mobile number
DECLARATION
I ______________________________________________ (full name), declare that to the best of my
knowledge the information provided in this application and in any resume enclosed is accurate and I
understand that if any false or misleading information is given, or any material fact suppressed, I will
not be employed, or if I am employed, my employment will be terminated. I also consent to New World
Albany retaining the information contained in this application form, for the purposes of considering my
suitability for any other position which may arise with this company in the future
Signed: ________________________________________ Date: ________________
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