MODERN SKATE & SURF - APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

NAME (LAST NAME– FIRST NAME)		SOCIAL SECURITY NO
PRESENT ADDRESS	CITY	STATE	ZIP CODE
PERMANENT ADDRESS	CITY	STATE	ZIP CODE
PHONE NUMBER	REFERRED BY

EMPLOYMENT DESIRED

POSITION DESIRED	DATE YOU CAN START	SALARY DESIRED
ARE YOU CURRENTLY EMPLOYED?	MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?
EVERY APPLIED TO THIS COMPANY BEFORE?	WHERE?		WHEN?
WHY ARE YOU APPLYING TO THIS COMPANY?

EDUCATION HISTORY

	NAME & LOCATION OF SCHOOL	YEARS ATTENDED	DID YOU GRADUATE?	SUBJECTS STUDIED
GRAMMER SCHOOL
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR OTHER SCHOOL

WHAT DO YOU DO THAT WE SELL?

FORMER EMPLOYERS

DATE, MONTH & YEAR	NAME & ADDRESS OF EMPLOYER	SALARY	POSITION	REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
FROM
TO

REFERENCES

(GIVE NAMES OF THREE PERSONS NOT RELATED TO YOU WHOM YOU HAVE KNOWN AT LEAST ONE YEAR)

NAME

ADDRESS

PHONE NUMBER

YEARS KNOWN

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.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.”

NAME

DATE

AVAILABILITY
Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday

* DO NOT WRITE BELOW THIS LINE *

REMARKS

NEATNESS		^CHARACTER
^PERSONALITY		^ABILITY
^HIRE DATE	^POSITION		^SALARY/WAGES

APPROVED BY

DATE