Employment - Rucker Mechanical

Employment Form

First Name

Last Name

Address

Street Address

City

State

Zip Code

Phone Number

Drivers License Number

Number of tickets in the last 3 years

Number of Accidents in the last 3 years

Age

Marital Status

EMPLOYMENT DESIRED

Position

Date

Salary Desired

Are you employed now?

May we inquire of your present employer?*

Yes

EDUCATION

Name of School

Years Completed

Did you graduate?

Yes

Subjects Studied/Degree Received

Name of School

Years Completed

Did you graduate?

Yes

Subjects Studied/Degree Received

Name of School

Years Completed

Did you graduate?

Yes

Subjects Studied/Degree Received

Additional information for education, if needed.

GENERAL

Current Trade Licenses Held (Copies provided)

Have you ever been convicted of a felony?

Yes

Have you ever been convicted of a DWI or had your driver's license revoked?

Yes

If yes, please give reason

FORMER EMPLOYERS

List Below your last four employers, starting with the most recent first

Employer Number 1

Name of Employer

Employed Date From

Employed Date To

Employer Address

City

State

Zip Code

Salary

Position

Reason for leaving

Contact First Name

Contact Last Name

Contact Phone Number

Employer Number 2

Name of Employer

Employed Date From

Employed Date To

Employer Address

City

State

Zip Code

Salary

Position

Reason for leaving

Contact First Name

Contact Last Name

Contact Phone Number

Employer Number 3

Name of Employer

Employed Date From

Employed Date To

Employer Address

City

State

Zip Code

Salary

Position

Reason for leaving

Contact First Name

Contact Last Name

Contact Phone Number

Employer Number 4

Name of Employer

Employed Date From

Employed Date To

Salary

Position

Employer Address

City

State

Zip Code

Reason for leaving

Contact First Name

Contact Last Name

Contact Phone Number

REFERENCES

List below three persons not related to you, whom you have known for at least one year

Reference Number 1

First Name

Last Name

Contact Phone Number

Position

Years Aquainted

Reference Number 2

First Name

Last Name

Contact Phone Number

Position

Years Aquainted

Reference Number 3

First Name

Last Name

Contact Phone Number

Position

Years Aquainted

Authorization

I authorize investigation on all statements contained in this application. I understand that misrepresentation of information requested is cause for dismissal. Furthermore, I understand and agree that my employment is for no definite period, and may, regardless of the date of payment of my wages and salary, be terminated at any time without case and without any previous notice.

I authorize information is correct

Yes

Today's Date