Kauffman Co. - Employment Application

Previous Employment History (up to 3)

Please fill in all required fields (marked with * )
1) Name of Previous Employer:
Name of last supervisor:
Employed from:

MonthDayYear
Date
Employed until:

MonthDayYear
Date
Address of Previous Employer:
Please include Street Address, City, State, and ZIP if possible.
Phone Number of previous employer:
Please enter a valid phone number.
Last job title:
Reason for leaving?
Please be as specific as you can.
List the jobs you held, duties performed, skills used or learned, advancements, or promotions you received while you worked at this company:
May we contact your previous employer?

YesNo
2) Name of Previous Employer:
Name of last supervisor:
Employed from:

MonthDayYear
Date
Employed until:

MonthDayYear
Date
Address of Previous Employer:
Please include Street Address, City, State, and ZIP if possible.
Phone Number
Please enter a valid phone number.
Last job title:
Reason for leaving?
Please be as specific as you can.
List the jobs you held, duties performed, skills used or learned, advancements, or promotions you received while you worked at this company:
May we contact your employer?

YesNo
3) Name of Previous Employer:
Name of last supervisor:
Employed from:

MonthDayYear
Date
Employed until:

MonthDayYear
Date
Address of Previous Employer:
Please include Street Address, City, State, and ZIP if possible.
Phone Number of Previous Employer:
Please enter a valid phone number.
Last Job Title:
Reason for Leaving:
Please be as specific as you can.
List the jobs you held, duties performed, skills used or learned, advancements, or promotions you received while you worked at this company:
May we contact your employer?

YesNo

Skills and References
General Skills:
If you have any relevant skills you would like us to know about, please enter them here.
Typing Skills:
If you have any relevant skills you would like us to know about, please enter them here.
Computer System Proficiencies?

PCMacBoth
Any application proficiencies?
If you have experience with any specific applications, please enter it here.
Any other skills you want to tell us about?
References

Please list 3 references below (other than relatives or previous employers)
Reference 1
Name
Position
Company
Phone Number
Please enter a valid phone number.
Reference 2
Name
Position
Company
Phone Number
Please enter a valid phone number.
Reference 3
Name
Position
Company
Phone Number
Please enter a valid phone number.
Application Statement and Signature
I certify that the answers provided are true and complete to the best of my knowledge.

I authorize you to make needed investigations of the above data as may be necessary in arriving at an employment decision.

I understand that this application is not intended to be and is not a contract of employment.

In the event of employment, I understand that false or misleading information I provide may result in discharge.

I further understand that I'm required to abide by all rules and regulations of the company.
Signature*

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Today's Date

MonthDayYear
Date
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Employment Application

Initial Application and Contact Information

Education and Additional Information

Previous Employment History (up to 3)

Skills and References

References

Reference 1

Reference 2

Reference 3

Application Statement and Signature