Last first Middle

RESIDENCE _________________________________________________________

STREET ADDRESS

_____________________________________________________________________

CITY STATE ZIP CODE

TELEPHONE _________________________________________________________

SOCIAL SECURITY NUMBER __________________________________________

DO NOT WRITE HERE – OFFICE USE ONLY

DATE OF INTERVIEW _ POSITION ____________________________

SALARY $ _______________________ INTERVIEWED BY ___________________

HIRE ______________________________ DEPT. ____________________________ SPECIAL NOTES ______________________________

TO BE COMPLETED IF & WHEN EMPLOYED

DATE OF BIRTH ________________ MARITAL STATUS ____________________

MAIDEN NAME IF APPLICABLE ____________________

EMPLOYMENT DATA:

REFERRED BY _____ ___ SALARY DESIRED ______________

APPLICATION FOR POSITION OF ______________________________________

FULL TIME PART TIME SUMMER TEMPORARY OTHER

ARE YOU WILLING TO WORK OVERTIME AS REQUIRED? YES NO

PERSONAL DATA:

I f you are not a U.S. citizen, what is your Alien Registration or Visa Classification Form Number?

Have you ever been convicted of any violation of law other than minor traffic violation? If yes, indicate disposition.

MEDICAL HISTORY:

Do you have any medical problem that would prevent you from performing the
job youapplied for? Yes No

If yes, please explain

EDUCATION:

NAME AND MAJOR DID YOU DATE OF

ADDRESS GRADUATE? ATTENDANCE

High School

College or University

Graduate School

Other

PREVIOUS EMPLOYMENT:

Are you now employed? _______

If so, may we inquire of your present employer? Present or last employment _______

Company/address _________________

Telephone _____________________________

Position/title _______________ Immediate Supervisor

From: Month______ _____Year _______ Starting Salary $ _____ per

To: Month_____Year _______ Final Salary $ _____ per

Reason for leaving_________________________ _______________________

Describe major duties

AS AN APPLICANT YOU AGREE TO AND UNDERSTAND THE FOLLOWING:

1) I understand Texan Publishers Inc. follows an employment-at-will policy, in that I or Texan Publishers may terminate my employment at any time, or for any reason consistent with applicable state or federal law. I understand that this application is not a contract of employment. I understand that to be employed I must be lawfully authorized to work in the United States, and I must show Texan Publishers documents that will prove this.

2) I understand that Texan Publishers will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools and firms named herein, except my current employer if so noted, to provide any information requestedabout me, and I release them from all liability for damage in providing this information.

3) I certify that all statements herein arc true and understand that any falsification or willful omission shall be sufficient cause for dismissal orrefusal of employment.

Signature of Applicant
Date _____________

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Дата добавления: 2015-07-11