1
NAME
LAST
FIRST
MIDDLE
PRESENT ADDRESS
STREET
CITY
STATE
ZIP
PERMANENT
ADDRESS
STREET
CITY
STATE
ZIP
PHONE NO. (INCLUDE
AREA CODE)
( ) -
( ) -
( ) -
HOME
CELL
OTHER
POSITION
DATE YOU CAN START
WHEN?
EDUCATION
NAME AND LOCATION OF SCHOOL
YEARS ATTENDED
DATE GRADUATED
SUBJECTS STUDIED
US MILITARY SERVICE
RANK
NATIONAL GUARD OR
RESERVE MEMBERSHIP
RANK
CIVIC OR VOLUNTEER
ACTIVITIES
CONTINUED ON REVERSE
DO YOU SPEAK OR WRITE
A FOREIGN LANGUAGE?
IF SO, WHICH?
We are a Drug-Free Workplace
STARR MANUFACTURING, INC. APPLICATION FOR EMPLOYMENT
HAVE YOU EVER BEEN CONVICTED OF A CRIME? YES NO
IF YES, EXPLAIN
ARE YOU A CITIZEN OF THE US? YES NO
EMPLOYMENT DESIRED
GRAMMAR SCHOOL
HIGH SCHOOL
SUBJECTS OF SPECIAL
STUDY OR INTEREST
COLLEGE
TRADE, BUSINESS OR
OTHER SCHOOL
IF NO, EXPLAIN
SALARY DESIRED
EVER APPLIED TO THIS COMPANY BEFORE? YES NO
ARE YOU EMPLOYED NOW? YES NO
IF YES, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? YES NO
2
FORMER EMPLOYERS: LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH MOST RECENT ONE FIRST.
DATE MONTH & YEAR
NAME, ADDRESS & PHONE # OF EMPLOYER
POSITION
SALARY
REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO
REFERENCES: GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
YEARS ACQUAINTED
NAME
ADDRESS
PHONE NUMBER
BUSINESS OR OCCUPATION
WHO REFERRED
YOU TO STARR?
IN CASE OF EMERGENCY NOTIFY
RELATIONSHIP
SIGNATURE
DATE
SIGNATURE
DATE OF BIRTH
REF W CONT
REF P CONT
BEGINNING
RATE OF PAY
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR IS
CAUSE FOR DISMISSAL. FURTHER, I UNDERSTAND AND AGREE THAT MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE