APPLICATION FOR EMPLOYMENT

PLEASE ENTER ALL INFORMATION, PRINT AND SUBMIT.
SIGN PRINTED COPY AND BRING TO THE INTERVIEW.

PERSONAL INFORMATION

First Name and MI: 
 
Last Name: 
Email Address: 
Street Address: 
Home Phone: 
 
Cell Phone: 
City: 
Work Phone: 
State: 
Zip:  

May we contact you at work?

 Yes No

Position Desired:
Date Available for Hire:
Availability:


If temporary, from: to:
Day and times NOT available to work:
Are you able to perform the essential functions of the position for which you have applied, with or without reasonable accomodation?

Are you prevented from becoming lawfully employed
because visa or immigration status?

Have you ever been convicted of or pled guilty to a felony?

If yes, please explain?

EDUCATION

Name and Location

Diploma/Degree

Major/Course Certification/Degree
 
High School
Diploma?   Yes  No
   GED
 
College
Degree?   Yes  No
Last Yr Attended: 
   
Other
Degree?   Yes  No
Last Yr Attended: 

MILITARY EXPERIENCE

Were you in the military service? Yes  No
If yes, what branch and rank at separation?
Briefly describe your duties and any special
training and/or skills.

CLARENDON COMPANIES HISTORY

Have you applied to Clarendon Companies before? Yes   No
Where?
When?
Have you been previously employed by Clarendon Companies? Yes   No
When?
Reason for leaving:
Were you referred to us by a current Clarendon Companies employee? If yes, please provide associate's name:
Do you have any relatives currently working for us? If yes, please indicate names and positions:


EMPLOYMENT HISTORY

State the following: (identify your last three employers, starting with the most current).

May we contact your current employer?     Yes No

EMPLOYER 1
Employer Name: 
Phone:
Employer Address: 
Supervisor Name: 
Title:
Your Job Title  
and Duties: 
Starting Salary: 
Ending Salary:
Reason for Leaving: 
Employed From: 
To:

EMPLOYER 2

Employer Name: 
Phone:
Employer Address: 
Supervisor Name: 
Title:
Your Job Title  
and Duties: 
Starting Salary: 
Ending Salary:
Reason for Leaving: 
Employed From: 
To:

EMPLOYER 3

Employer Name: 
Phone:
Employer Address: 
Supervisor Name: 
Title:
Your Job Title  
and Duties: 
Starting Salary: 
Ending Salary:
Reason for Leaving: 
Employed From: 
To:

REFERENCES

Give the names of three persons you have known at least one year and who are not related to you.
 
Name Address/Phone (or email) Business Years
Acquainted
1
2
3


In case of emergency contact: 
 
Name: 
Address: 
Phone Number:  Alternate Number:
Relationship: 



CERTIFICATE OF APPLICANT
(READ CAREFULLY BEFORE SIGNING)

I certify that the information in this application (and accompanying resume or information) is true. I also agree and understand that misrepresentations or false or omitted facts may disqualify me from further consideration for employment and may be considered justification for my termination if discovered at a later date.

I authorize investigation of the statements contained herein and the references listed above to give you any and all information such persons, schools, and employers or organizations may have, and release all parties from all liability for any damage that may result from furnishing this information to you. I authorize you to request and receive any and all information from my entire work and personal history.

I understand that, if hired, my employment is for no definite period and may be terminated at any time, with or without cause, at the discretion of either the company or myself. I understand that I will remain an at will employee and can be terminated at any time without any notice, absent a written contract signed by the President of the Company and myself. If I am employed, it is also understood that the Company, at its sole option and without prior notice, can change wages, benefits, rules, regulations and the conditions of my employment at any time.

I acknowledge that I may be offered employment subject to a medical examination and/or questionnaire, and that such examination and/or questionnaire could nullify my ultimate employment by this employer. I agree to submit to any such medical examination and/or questionnaire.

Signature of Applicant

Date



Please print the form before submitting. Then sign the printed copy and bring to the interview.


            

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