Application For Employment

Western NY Sealing and Paving

Application for Employment
Candidate's Name
Date

MonthDayYear
Address
Telephone Number
Are you 18 years of age or older?

YesNo
Are you either a U.S. citizen or an alien authorized to work in the U.S.?

YesNo
Have you ever worked or attended school under another name? If so, under what name?

WORK EXPERIENCE
Please list all previous employment, beginning with the most recent. If you need more room, you may upload a document at the end of the form.
Employer (Work Experience #1)
Address
From
START DATE
To
END DATE
Position Held
Reason for Leaving
Supervisor's Name & Title
May we contact?

YesNo
Description of Duties
Starting Compensation
Final Compensation
Employer (Work Experience #2)
Address
From
START DATE
To
END DATE
Position Held
Reason for Leaving
May we contact?

YesNo
Supervisor's Name & Title
Description of Duties
Starting Compensation
Final Compensation

AUTHORIZATION & ACKNOWLEDGEMENTS
I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge.

I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.
Candidate's Signature*

Clear
Date*

MonthDayYear
Date
Your Email*
example@example.com
Should be Empty:

Western NY Sealing and Paving