Hourly Application Form For Employment Page 3
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1
2
314.
Education
Name and Location
Dates
Major/
Degree
Last Grade Completed
of School
Attended
Speciality
Received
High School
(Please leave blank)
(Please leave blank)
From
/
Month
Year
University/ Other
(Please leave blank)
To
/
Month
Year
15.
Work History (List your last 3 jobs.)
Current or Most Recent Job
Previous Job
Previous Job
Company Name
Address
Position and Job
Duties (please describe)
Name and Title of
Immediate Supervisor
Phone Number of
Immediate Supervisor
May we contact this
person as a reference?
Yes
No
Yes
No
Yes
No
Dates of Employment
/
to
/
/
to
/
/
to
/
Month
Year
Month
Year
Month
Year
Month
Year
Month
Year
Month
Year
Usual No. of Hours
Worked per Week
Reason for Leaving
$
$
$
$
$
$
Hourly Earnings
Starting
Ending
Starting
Ending
Starting
Ending
16.
Personal References (other than immediate family):
Name
Phone Number
Number of years known
Relationship
1.
2.
17.
Do you understand the basic job requirements of the position applied for? .......................................................................................
Yes
No
18.
Can you perform the essential functions required by the job for which you are applying either with or without
reasonable accommodations? ............................................................................................................................................................
Yes
No
20.
We have specific requirements for personal appearance (as provided).
Are you willing to meet our requirements? .........................................................................................................................................
Yes
No
21.
How did you hear we were hiring? (please circle) Hcareers
Kijiji
Craiglist Indeed
Facebook
Twitter
Other________________________
PLEASE READ THE FOLLOWING CAREFULLY AND SIGN BELOW
I declare that I am qualified to perform all the duties of the position that I am seeking. I also declare that the information I have provided on this application is correct and that
any false statements or omissions will justify my rejection or dismissal. I authorize the company to contact any of my previous employers as well as any reference source to
verify the facts and information that I have furnished regarding my qualifications and character. I authorize any person(s) having knowledge to provide such information in
good faith. I authorize SIR Corp. and its agents to verify any information related to my application or résumé.
SIGNATURE:
DATE:
I UNDERSTAND THAT MY APPLICATION WILL REMAIN ACTIVE FOR 30 DAYS FROM THE DATE RECEIVED. SIR CORP. IS AN EQUAL OPPORTUNITY EMPLOYER.
2
CONFIDENTIAL PROPERTY OF SIR CORP
2
REV 06/2014
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