Employment Application | McCook Gazette

Today's Date:

Applicant Information

Name:

Street address:

City, State, ZIP:

Phone number:

Email address:

Social Security No.:

If you are uncomfortable submitting this information online, you may submit it in person if you are offered a position.

Date available:

Position applying for:

Desired salary:

Are you a citizen of the United States? Yes
No

If no, are you authorized to work in the United States? Yes
No

Have you ever worked for this company? Yes
No

If so, when:

Have you ever been convicted of a felony? Yes
No

If yes, explain:

Previous Employment

Previous Employer 1

Employer #1

Company name:

Phone:

Address:

Supervisor:

Job Title:

Starting and ending salary:

Responsibilities:

When where you employed there?

Reason for leaving:

May we contact your previous supervisor for a reference? Yes
No

Previous Employer 2

Employer #2

Company name:

Phone:

Address:

Supervisor:

Job Title:

Starting and ending salary:

Responsibilities:

When where you employed there?

Reason for leaving:

May we contact your previous supervisor for a reference? Yes
No

Previous Employer 3

Employer #3

Company name:

Phone:

Address:

Supervisor:

Job Title:

Starting and ending salary:

Responsibilities:

When where you employed there?

Reason for leaving:

May we contact your previous supervisor for a reference? Yes
No

Education

High school

Name of high school:

Address of high school:

Years attended?

Did you graduate? Yes
No

College

Name of college:

Address of college:

Years attended?

Did you graduate? Yes
No

Degree(s)?

Other education

Name of institution:

Address:

Years attended?

Did you graduate? Yes
No

Degree(s)?

References

Reference #1

Full name:

Relationship:

Company:

Address:

Phone:

Reference #2

Full name:

Relationship:

Company:

Phone:

Address:

Reference #3

Full name:

Relationship:

Company:

Phone:

Address:

Military Service

What branch did you serve in?

Time period you served?

Rank at discharge?

Type of discharge?

If other than honorable, explain:

Documents

Upload a Resume:

Upload additional information:

Disclaimer and signature

Sign your name:

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I understand that drug testing is a condition of employment.

Date: