Job Application - Lammers Trailer Repair

Applicant Information

Last Name

First Name

M.I.

Street Address

Apt/Unit #

City

State

ZIP

Phone

Email

Date Available

Desired Salary

Position You're Applying For

Are you a citizen of the United States?

YesNo

Are you authorized to work in the U.S.?

YesNo

Have you ever worked for this company before?

YesNo

When did you work for this company?

Have you ever been convicted of a felony?

YesNo

Please Explain

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Education

High School

Address

Date From

Date To

Did you graduate?

YesNo

College

Address

Date From

Date To

Did you graduate?

YesNo

Degree

Other Education

Address

Date From

Date To

Did you graduate?

YesNo

Degree

References

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Previous Employment

List most recent employment first.

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

0 /

Date From

Date To

Reason for Leaving

May we contact your previous employer for a reference?

YesNo

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

0 /

Date From

Date To

Reason for Leaving

May we contact your previous employer for a reference?

YesNo

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

0 /

Date From

Date To

Reason for Leaving

May we contact your previous employer for a reference?

YesNo

Military Service

Have you served in the military?

YesNo

Branch

Date From

Date To

Rank at Discharge

Type of Discharge

If other than honorable, please explain:

0 /

Disclaimer and Signature

I certify that my answers and true 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.

I acknowledge that my electronic signature below shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

Electronic Signature / Full Name

Date