List name, address and phone number of previous employers in chronological order.
Title:
Employer:
Address:
Phone:
Duties:
From (date):
To (date):
Supervisor
Last Salary
From
To
Skills
Typing WPM:
Shorthand Dictaphone Calculator 10-key Personal Computer Software: Excel Word Outlook Access Internet Explorer Other :
Other skills and knowledge:
Military
References
Statement
Please add any additional information you may think helpful to your consideration for employment:
Signature
READ THIS SECTION PRIOR TO PROVIDING SIGNATURE BELOW
I, the undersigned, agree that this organization may make any lawful inquiry that it considers necessary to determine my eligibility for employment. I authorize this organization to seek and obtain from my present and former employers, schools and personal references, information relating to my qualifications for employment. I release this organization and all persons and entities furnishing such information to this organization form any liability arising from dissemination or publication of such information.
I understand that any job offer with this organization is conditioned upon my ability to establish employment eligibility under the Immigration Reform and Control Act of 1986.
AGREEMENT FOR DRUG AND ALCOHOL TESTING. I freely and voluntarily agree to submit to a drug test as part of my application for employment. I understand that either refusal to submit to the test or failure to meet the standards established by this organization for this test may disqualify me for employment.
All information provided in this application and any accompanying resume is true and complete. I agree that any false or misleading representation or material omission may disqualify me from consideration for employment and may result in discharge, regardless of when discovered.
I have read and understand the foregoing and I agree unconditionally to the foregoing.
* I agree
* Date: -- --
