Employment Application (Page 3 of 3) in pdf

NAME AND ADDRESS

MO. YR.

NAME, TITLE, & PHONE

TITLE OF POSITION &

RATE OF

REASONS FOR LEAVING

OF EMPLOYER

NUMBER OF IMMEDIATE

DESCRIPTION OF JOB

PAY

SUPERVISOR

PERFORMED

NAME (PRESENT OR LAST EMPLOYER)

FROM

START

ADDRESS

LEAVE

NAME (NEXT PREVIOUS)

FROM

START

ADDRESS

LEAVE

NAME (NEXT PREVIOUS)

FROM

START

ADDRESS

LEAVE

MAY WE CONTACT YOUR PRESENT EMPLOYER? _____ YES

_____ NO

PREVIOUS EMPLOYER?

_____ YES

_____ NO

IF YES, IN WHAT JOB?

FROM

Where you ever employed by us before?

REASON FOR LEAVING?

Consistent attendance and punctuality are essential requirements of every job with this company. Is there anything which would interfere with your regular attendance and

punctuality if you are offered a job with Cornell? _____Yes

____ No

Explain:

LIST THREE PERSONAL REFERENCES (EXCLUDE RELATIVES)

NAME

RELATIONSHIP TO YOU

PHONE

APPLICANT’S STATEMENT AND AGREEEMENT

Read the following carefully before signing this application for employment.

The information provided by me in this application is true and complete to the best of my knowledge. Should I be employed by this Company, any misrepresentations or any false

statement contained herein may be considered cause for possible dismissal.

The Company, in compliance with the provisions of the Fair Credit reporting Act of Sept. 1997, may contact directly or employ the services of investigative agencies to obtain all

necessary information from the references I have listed, or any other sources, concerning my prior employment, personal history or credit standing. I reserve the right to know the names

and addresses of any investigative agencies in order that I may learn the information contained in any reports furnished to the Company.

I understand this application does not constitute an employment contract of any kind. Should I be employed by the Company, I may resign such employment at any time at my discretion

with or without prior notice and the Company may terminate my employment at any time in their discretion, with or without cause and with or without prior notice.

This application will be considered valid for a period of 60 days. After 60 days it will be necessary for me to submit a new application.

Signature of Applicant __________________________________________________________________________________ Date ____________________________________

--Attach any additional information or documents to this application –