Application for employment



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Date11.12.2016
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APPLICATION FOR EMPLOYMENT


Stanly

Communications, Inc.

Date of Application

     


Social Security Number

     


Last Name

     


First Name

     


Middle Name

     


Address (Street number and name)

     


City

     


Date of Birth

     


Job Applied For

     


Marital Status

     


Phone (Home or where you can be reached)

     


Business Phone

     


Describe your general health status

Please list any serious illness in the past 5 years, you may use additional paper or space if necessary.

     


Referral Source

Please indicate your referral source:      




Education

Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 2 3 4 Graduate School 1 2 3 4


High School



     

     


      to      

Grad?

S/Q Hrs.

Major/Minor Course Work



Type of Degree Received

College(s)

University (s)



     

     


      to      

YES 

NO 











Graduate or

Professional



     

     


      to      

YES 

NO 


     

     

     

Special training programs and seminars you have completed in the last five years (list):

     








YES 

NO 


     

     

     

Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not mean you cannot be hired. The offense and how recently you were convicted will be evaluated in relation to the job for which you are applying.)  YES  NO (If yes, explain fully on an additional sheet.)

WORK HISTORY Use Additional Sheets if Necessary

Current or Last Employer:

     


Address:

     


Job Title:

     


Supervisor’s Name

     


Telephone Number

     


No. Supervised by you:

     


Date Employed (mo/yr)

     


Starting Salary

$      per      



Ending or Current Salary

$      per      



Reason for Leaving

     


May We Contact Employer

YES  NO 



Date Separated (mo/yr)

     


Full Time Years Months

           

Part Time Years Months

           

If part time, number of hours worked per week:      


List major duties and any comments:

     


Employer:

     


Address:

     


Job Title:

     


Supervisor’s Name

     


Telephone Number

     


No. Supervised by you:

     


Date Employed (mo/yr)

     


Starting Salary

$      per      



Ending or Current Salary

$      per      



Reason for Leaving

     


Date Separated (mo/yr)

     


Full Time Years Months

           

Part Time Years Months

           

If part time, number of hours worked per week:      


List major duties and any comments:

     


References

Please list Name, Address, Occupation and Phone number of each Reference

1:      


2:      


Equal Opportunity Information

Stanly Communications, Inc. does not discrimination based on race, sex, color, creed, national origin, age or disability.



I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigation of all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information may be grounds for rejection of my application, and (or) criminal action. I further understand that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet position qualifications.

Signature of Applicant (unsigned applications will not be processed)



     

Date


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