AJAX Distributin Co. Application

Candidate's Name:     Date:

Email:

Address:

Telephone Number:

Are you either a U.S. citizen or alien authorized to work in the U.S.? YesNo

Have you ever worked or attended school under another name?
If so, under what name?

 

POSITION DESIRED

Position:

Start Date Available:     Salary Desired:

Have you previously worked for this company? YesNo

If so, from:   to  

Reason(s) for leaving:

Former supervisor(s) at this company:

How did you learn about this opening?

 

EDUCATION

High School:
Graduated? YesNo      Course of Study

College/University:
Graduated? YesNo      Course of Study

Postgraduate School:
Graduated? YesNo      Course of Study

Other education, training or special skills:

 

MILITARY EXPERIENCE

Branch of Service:

Dates Served:       Rank at Discharge:

Education and Training:

*If you have military experience please be prepared to provide your DD214.

 

WORK EXPERIENCE

Please list all previous employment, beginning with the most recent. If you need more room, you may attach a WORD document or equivalent file type in the appropriate area at the bottom of this section.

 

EMPLOYER 1

Employer:

Address:

From: to

Position Held:

Reason for leaving:

Supervisor's Name & Title:

May we contact? YesNo

Description of Duties:

Starting Salary:       Final Salary:

 

EMPLOYER 2

Employer:

Address:

From: to

Position Held:

Reason for leaving:

Supervisor's Name & Title:

May we contact?
YesNo

Description of Duties:

Starting Salary:        Final Salary:

 

Additional Employer Information

 

REFERENCES

Please list three references other than relatives or previous employers.

 

Reference 1

Name:   Title:

Company:   Phone:

Address:

Type: BusinessPersonal

 

Reference 2

Name:   Title:

Company:   Phone:

Address:

Type: BusinessPersonal

 

Reference 3

Name:    Title:

Company:   Phone:

Address:

Type: BusinessPersonal

 

Have you ever been convicted of a crime?*
YesNo
If yes, give details, including date(s):

* A "yes" answer will not automatically disqualify you from employment. We will consider the nature and date of the offense and the job for which you are applying for job-related purposes only, and only to the extent permitted by applicable law.

 

Authorization and Acknowledgements

(1) I certify that I have not knowingly withheld any information that might affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material face on the application or on any document used to secure this employment can be grounds for rejection of my application or, if I am employed by this company, can be grounds for my immediate termination for the company. (Initial)

(2) I permit the company to check and verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation. (Initial)

I certify that information contained in this application is true and complete. I understand that false information may be ground for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any and all information listed above.

Candidate's Signature: (Please Type)      Date:

Electronic Signature

By checking this box, I certify that I am the person identified in this application and that all information provided herein is true and correct. I further acknowledge that I have read and understand this application and all attachments. I understand that incomplete or false answers may be grounds for ineligibility or termination. I understand that an electronic signature has the same legal effect and enforceablility as a written signature on an application.

AgreeDisagree