Advanced Glazing Contractors, Inc. - Employment Application

Background Questions

	YES	NO	Explain if Necessary
Are you a citizen of the United States?
If "no" to above, are you authorized to work in the United States?
Have you ever worked for this company before? If yes, when?
Have you ever been convicted of a felony? if yes, explain.
Do you have a valid driver's license?
If "yes" to above, do you have any points against your license?
Are you available to work out of town, overnight, or weekly schedule?
Do you agree to random drug screening (in house only)?

Education
High School*
Year of Graduating Class*
Did you graduate?*

YesNo
References
Reference 1
Full Name*
Relationship*
Company*
Phone Number*
Please enter a valid phone number.
Reference 2
Full Name*
Relationship*
Company*
Phone Number*
Please enter a valid phone number.
Previous Employment
Company*
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Responsibilities*
Job Title*
Ending Salary*
Reason For Leaving*
Supervisor*
May we contact your previous supervisor for a reference?*

YesNo
Disclaimer & Signature
I certify that my answers are tru 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.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Employment Application