Employment - DeSitter Flooring

Employment Application

Application Information

Full Name:			M.I.
	Last	First

Address:
	Street Address	Apartment/Unit #


	City	State	ZIP Code

Phone:		Email:

Position Applied for:

Date: Available:		Social Security No.:		Desired Salary:	$

Are you a U.S. Citizen?	Yes No	If no, are you authorized to work in the U.S.?	Yes No

Years in flooring industry

Have you ever been convicted of a felony?	Yes No	Able to work evenings, overnights & weekends?	Yes No

If yes, explain:

Education

High School:		Address:

From:		To:		Did you graduate?	Yes No	Degree:

College:		Address:

From:		To:		Did you graduate?	Yes No	Degree:

Other:		Address:

From:		To:		Did you graduate?	Yes No	Degree:

References

	*Please list three professional references

Full Name:		Relationship:

Company:		Phone:

Address:

Full Name:		Relationship:

Company:		Phone:

Address:

Full Name:		Relationship:

Company:		Phone:

Address:

Previous Employment

Company:		Phone:

Address:		Supervisor:

Job Title:		Starting Salary:		Ending Salary:

Responsibilities:

From:		To:		Reason for Leaving:

May we contact your previous supervisor for a reference?	Yes No

Company:		Phone:

Address:		Supervisor:

Job Title:		Starting Salary:		Ending Salary:

Responsibilities:

From:		To:		Reason for Leaving:

May we contact your previous supervisor for a reference?	Yes No

Company:		Phone:

Address:		Supervisor:

Job Title:		Starting Salary:		Ending Salary:

Responsibilities:

From:		To:		Reason for Leaving:

May we contact your previous supervisor for a reference?	Yes No

Military Service

Branch:		From:		To:

Rank at Discharge:		Type of Discharge:

If other than honorable, explain:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Online Signature:

Date: