Personal Information
    Employment Desired
    Monday – FridayTuesday – Saturday


    Education History
      Name & Location of School Years Attended Did you Graduate Subjects Studied
    High school
    College
    Trade, business, or correspondence school
    General Information
    Former Employers (List your last four employers, starting with last one first.)
    DATE (MONTH & YEAR)
    NAME & ADDRESS OF EMPLOYER
    SALARY & POSITION
    REASON FOR LEAVING



    References (Give the names of three persons not related to you, whom you have known at least one year.)
    NAME
    ADDRESS
    BUSINESS
    YEARS KNOWN
    Certification and Understanding
    APPLICANT PLEASE READ CAREFULLY

    I agree to comply with all rules of this company, I hereby affirm that all the foregoing statements are true and correct and that I have not knowingly withheld any fact that would, if disclosed, affect my application unfavorably. I hereby authorize the company to conduct any investigation it deems necessary with respect to information set forth on this application. I also hereby authorize this company to release such information together with their opinions on these matters without any liability for any damages whatsoever caused either directly or indirectly by giving or receiving such information or opinions. I authorize any former employer, present employer, schools, colleges, and universities utility companies, credit, finance bureau/offices, personal references, and/or other persons to give any information they may have concerning my character, health, credit, and employment record. I hereby unconditionally release any names informant form any and all liability resulting from the furnishing of this information.

    I understand that nothing herein or otherwise shall be deemed to create any contract of employment between the company and me and that my employment may be terminated by the company or me at any time without advances notice one to the other.

    In making this application for employment, I also understand than an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative consumer report.