Employment Application

Personal Information
Name*
First Last
Social Security Number*
Present Address*
Street Address Address Line 2 City State ZIP Code
Permanent Address*
Street Address Address Line 2 City State ZIP Code
Phone No.*
Secondary Phone No.*
Referred by

Employment Desired
Position*
Date you Can Start*
Date Format: MM slash DD slash YYYY
Salary Desired*
Are You Employed Now?*
- Yes
- No
If So, May We Inquire of Your Present Employer?
- Yes
- No
Have You Ever Applied to Southern Scapes Before?*
- Yes
- No
Where?
When?

Education History
High School
Name & Location of School*
Years Attended*
Did you Graduate?*
- Yes
- No
- Currently Attending

College
Name & Location of School
Years Attended
Did you Graduate?
- Yes
- No
- Currently Attending
Subjects Studied

Trade, Business or Correspondence School
Name & Location of School
Years Attended
Did you Graduate?
- Yes
- No
- Currently Attending
Subjects Studied

General Information
Subject of Special Study / Research Work
Special Training
Special Skills
U.S. Military or Naval Service
Rank

Former Employment

List your last 4 Employers, STARTING with the LAST one first.
Employer 1
From*
To*
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Salary*
Position*
Reasons For Leaving*

Employer 2
From*
To*
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Salary*
Position*
Reasons For Leaving*

Employer 3
From
To
To
Company Name
Address
Street Address Address Line 2 City State ZIP Code
Salary
Position
Reasons For Leaving

Employer 4
From
To
Company Name
Address
Street Address Address Line 2 City State ZIP Code
Salary
Position
Reasons For Leaving

References

Give names of 3 persons NOT RELATE TO YOU, whom you have known for at least one year.
Reference 1
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Business*
Years Known*
Please enter a number less than or equal to 2.

Reference 2
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Business*
Years Known*
Please enter a number less than or equal to 2.

Reference 3
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Business*
Years Known*
Please enter a number less than or equal to 2.

Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employees listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and relate the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release of use of disability-related or medical information in the manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. i also understand that a poor credit history or conviction will not automatically result in disqualification from employment.”

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
Date*
Date Format: MM slash DD slash YYYY
Signature*
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Personal Information

Employment Desired

Education History

High School

College

Trade, Business or Correspondence School

General Information

Former Employment

List your last 4 Employers, STARTING with the LAST one first.

Employer 1

Employer 2

Employer 3

Employer 4

References

Give names of 3 persons NOT RELATE TO YOU, whom you have known for at least one year.

Reference 1

Reference 2

Reference 3

Authorization