Employment

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Employment Desired
Position*
Date You Can Start*
MM slash DD slash YYYY
Salary Desired*
Are You Employed Now?
If So May We Inquire Of Your Present Employer?
Ever Applied To This Company Before?
Where Did You Apply?
When Did You Apply?
MM slash DD slash YYYY
Referred By
Education Details
Grammar School
Name and Location of School
*No of Years Attended
*Did You Graduate?
Subjects Studied
High School
Name and Location of School
*No of Years Attended
*Did You Graduate?
Subjects Studied
College
Name and Location of School
*No of Years Attended
*Did You Graduate?
Subjects Studied
Trade, Business or Correspondence School
Name and Location of School
*No of Years Attended
*Did You Graduate?
Subjects Studied
Personal Information
Name*
First Last
Present Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Permanent Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Are You 18 Years Or Older?*
- Yes
- No
Are You Prevented From Lawfully Becoming Employed In This Country Because Of Visa Or Immigration Status*
- Yes
- No
GENERAL
Subjects of Special Study or Research Work
Special Skills
Activities: (Civic, Athletic Etc.)
EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE. CREED. SEX. AGE. MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.
U. S Military or Naval Service
Rank
Present Membership in National Guard or Reserves
FORMER EMPLOYERS
(List Below Last Three Employers Starting With Last One First).
Date Month & Year(From & To)
Name and Adress of Employer
Salary
Position
Reason For Leaving
Date Month & Year(From & To)
Name and Address of Employer
Salary
Position
Reason For Leaving
Date Month & Year(From & To)
Name and Address of Employer
Salary
Position
Reason For Leaving
Date Month & Year(From & To)
Name and Address of Employer
Salary
Position
Reason For Leaving
Date Month & Year(From & To)
Name and Address of Employer
Salary
Position
Reason For Leaving
Which Of these Jobs Did You Like Best?
What Did You Like Most About This Job?
REFERENCES:
Give the names of three persons not related to you, whom you have known at least one year.
1 Name
Address
Business
Years Acquainted
2 Name
Address
Business
Years Acquainted
3 Name
Address
Business
Years Acquainted
The Following Statement Applies in: MARYLAND & MASSACHUSETTS. [Fill in name of state.;
It is Unlawful in the state of
TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
Signature
IN CASE OF EMERGENCY NOTIFY
Name
Address
Phone No
*I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE. AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANYS OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IPS PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.
Date
MM slash DD slash YYYY
Signature
This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.