APPLICATION FOR EMPLOYMENT

Name (required)

Email (required)

Phone Number (required)

Social Security Number

Date of Birth

Are you eligible to work in the US?
 yes no

Address

City, State, Zip




Position Desired

Are you currently employed?
 yes no

Have you applied to this company before?
 yes no

Date available to start

Desired salary

May we contact your current employer?
 yes no




High School

Did you graduate?
 yes no

Year graduated

Subject studied

College

Did you graduate?
 yes no

Year graduated

Subject studied

Trade, Business, or other school

Did you graduate?
 yes no

Year graduated

Subject studied




EMPLOYER HISTORY

Employer Name and Address 1

Job title / Description of duties

Name of supervisor

Starting salary

Ending salary

Dates

May we contact them?
 yes no




Employer Name and Address 2

Job title / Description of duties

Name of supervisor

Starting salary

Ending salary

Dates

May we contact them?
 yes no




REFERENCES

Reference 1

Relationship

Contact number

Years known


Reference 2

Relationship

Contact number

Years known


Reference 3

Relationship

Contact number

Years known




I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of The KeVen Parker Company has any authority to enter unto any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized representative of The KeVen Parker Company. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws.

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