synergie-llc.com - Application For Employment

APPLICATION FOR EMPLOYMENT

(Pre-Employment Questionnaire) (An Equal Opportunity Employer)
Name and Address
Name

First NameMiddle NameLast Name
Job Applying For
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
If under 18, please list age
Email
example@example.com
Job Type
Days/hours available to work

I have no preference.Mon.Tues.Wed.Thurs.Fri.Sat.Sun.
I am seeking a:

Full‐time jobPart‐time jobFull‐ or Part‐time
How many hours can you work weekly?
Can you work nights?
Date available to begin
Additional Information
Have you ever been employed by this organization in the past?

YesNo
I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States.

YesNo
Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony?

YesNo
If Yes, please explain:
Do you have a driver's license?

YesNo
Driver's license number
Issued in what state?
Education

Education Information

Rows	School Name	Location (mailing address)	Years Completed	Major Degree or Diploma
High School
College or Business/Trade School
College or Business/Trade School 2

LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST

Rows	FROM (Date, Month and Year):	TO (Date, Month and Year/ Current)	NAME OF EMPLOYER	ADDRESS OF EMPLOYER	SALARY	POSITION	REASON FOR LEAVING
1.
2.
3.

Which of these jobs do you like best?
What did you like most about this job?
References
Please include name, phone number, and circumstances of your acquaintance. Give the names of three persons not related to you, whom you have known at least one year.
I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company terminated.
Signature
Date

MonthDayYear
Date
Should be Empty:

APPLICATION FOR EMPLOYMENT