Application for Employment
Personal Information:
Date:_______________________ Social Security Number_____________________________________
Name: _______________________________________________________________________________
Last First M.I.
Present Address:_______________________________________________________________________
Street City State Zip
Telephone Number: ____________________________________________________________________
Citizen of the
If you are related to anyone in our employ, state name and
department:____________________________
New York State Law
prohibits discrimination because of race, color, creed, nationality, sex age
disability or marital status.
Employment Desired:
Position Date
you can start Salary
desired
State place of current employment:_________________________________________________________
May we contact your current employer?_____________________________________________________
Have you ever applied to this district before?_______ Where?_________________When_____________
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Education: |
Name/location of school |
Years Attended |
Date graduated |
Subjects Studied |
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Elementary School |
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High School |
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College |
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Trade/Business/ Correspondence
School |
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Rank Present membership in Reserves/National Guard
Activities (Civic, Athletic, fraternal, etc.)____________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________________________________
Former Employers: (List last four employers below, starting with the most recent)
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Date: month/year |
Name/address of employer |
Position |
Salary |
Reason for Leaving |
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From: To: |
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References: Give below the names of three persons not related to
you, whom you have known at least one year.
Name Address Business Years acquainted
1.
2.
3.
I authorize investigation of all statements contained in this application. I understand that misrepresentations or omissions of facts called for are cause for dismissal. Further, I understand that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.
Date Signature
Do Not Write Below This Line
Interviewed by:________________________________________________________
Date:____________________________
Remarks:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Neatness______________Character___________________Ability________________
Personality_______________________
Hired________________________
For department__________________________Position____________________________
Will report:____________________________________________
Salary/Wages_____________________________________
Approved By:_____________________________________________________________