Employment Application Position Position Applied For Name First name Middle name Last name Contact Email address Home phone number Business phone number Address Street address City State Zip code Previous Employment 1 May we contact this previous employer? Yes No Employment 1: position title Employment 1: employer Employment 1: address Employment 1: phone number Employment 1: business type Employment 1: immediate supervisor Employment 1: supervisor’s title Employment 1: starting salary Employment 1: ending salary Employment 1: start date month/year Employment 1: end date month/year Full-time Part-time Employment 1: hours/week Employment 1: duties Employment 1: equipment used Employment 1: reason for leaving Employment 1: your name while employed, if different from current name Previous Employment 2 May we contact this previous employer? Yes No Employment 2: position title Employment 2: employer Employment 2: address Employment 2: phone number Employment 2: business type Employment 2: immediate supervisor Employment 2: supervisor’s title Employment 2: starting salary Employment 2: ending salary Employment 2: start date month/year Employment 2: end date month/year Full-time Part-time Employment 2: hours/week Employment 2: duties Employment 2: equipment used Employment 2: reason for leaving Employment 2: your name while employed, if different from current name Reference 1 Reference 1: name Reference 1: address Reference 1: phone number Reference 1: relationship Reference 2 Reference 2: name Reference 2: address Reference 2: phone number Reference 2: relationship Reference 3 Reference 3: name Reference 3: address Reference 3: phone number Reference 3: relationship Law Violations Have you ever been convicted of a law violation(s) (including moving traffic violations but excluding offenses committed before your eighteenth birthday which were finally adjudicated in a Juvenile Court or under youth offender law)? Yes No If “yes” for violations, list all Certification Application certification I hereby certify that all entries on both sides and attachments (if any) are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employment in the service of Green Valley Book Fair, Inc. I understand that all information on this application is subject to verification and I consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize Green Valley Book Fair, Inc. to rely upon and use, as it sees fit, any information received from such contacts. Please enable JavaScript for this form to work.
