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AMS Job Application

Personal Information
Name First: Last:
Social Security Number:
Present Address:
 Apt #
 City
 State:
 Zip Code:
Permanent Address:
 Apt #
 City State:
 Zip Code:
Are you 18 years or older?  Yes  No Phone:
Desired Employment
Position:
 Date you can start:
 Salary Desired:
Are you employed now? Yes No If so may we inquire of your present
employer?    Yes No
Have you ever applied to this
company before? Yes  No		 Where?
 When?
Have you ever worked for this company before? Yes  No Where?
 When?
Reason for leaving?
Name of last supervisor:
Who referred you to this company?  Employment Agency  Newspaper Ad  Friend Other
Received Personalized Postal Letter State Unemployment Agency   College Placement  Walk-In 
Education
School Level Name & Location Years Attended Did You Graduate? Subjects Studied
High School     Yes 
No		  
College     Yes 
No		  
Trade, Business or Correspondence School     Yes 
No		  
General
Subjects of special study or research work:
Special training:
Special skills:
Former Employers
List Below last three employers, starting with the most recent one first.
Name of present or last employer:
Address:
 City:
 State:
 Zip:
Starting date:
 Leaving date:
 Job title:
Name of supervisor:
 Title:
 Phone:
Description of work:
Reason for leaving:
Name of previous employer:
Address:
 City:
 State:
 Zip:
Starting date:
 Leaving date:
 Job title:
Name of supervisor:
 Title:
 Phone:
Description of work:
Reason for leaving:
Name of previous employer:
Address:
 City:
 State:
 Zip:
Starting date:
 Leaving date:
 Job title:
Name of supervisor:
 Title:
 Phone:
Description of work:
Reason for leaving:
References

Name

Address

Business

Yrs. Acquainted
1      

 
2      

 
3      

 
Service Record
Branch of Service:
 Discharge (date-rank)
Have you been convicted of a felony within the last 5 years? Yes  No
If yes, explain. (Will not necessarily exclude you from consideration)
Authorization

" I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."

 

Date                     Signature