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CONTACT
Application for Employment
Name
Phone Number
Date
Permanent Address
City
State
Zip Code
Email
Referred By
Employment Desired
Position
Date you can start
Hourly rate/salary desired
Are you currently employed?
Yes
No
Where?
Current dates of employment
Are you legally authorized to work in the US?
Yes
No
Have you ever applied to FlagZone before?
Yes
No
When
Have you ever worked for FlagZone before?
Yes
No
Reason for leaving
Name of last supervisor
Full Time
Yes
No
Part Time Availability (Daily Hours)
Sessional Availability (Days & Hours)
Education
High School
Name and location of school
Years attended
Did you graduate?
Subjects studied
College
Name and location of College
Years attended
Did you graduate?
Subjects studied
Trade, business, or correspondence school
Name and location of school
Years attended
Did you graduate?
Subjects studied
Military Service
Have you ever served in the armed forces?
Yes
No
Branch of service
Discharge date
Rank
Employment History
History 1
Name of previous employer
Address
Job Title
Start date
End date
Reason for leaving
Starting rate/salary
Ending rate/salary
Eligible for rehire?
Yes
No
Description of work
History 2
Name of previous employer
Address
Job Title
Start date
End date
Reason for leaving
Starting rate/salary
Ending rate/salary
Eligible for rehire?
Yes
No
Description of work
History 3
Name of previous employer
Address
Job Title
Start date
End date
Reason for leaving
Starting rate/salary
Ending rate/salary
Eligible for rehire?
Yes
No
Description of work
References
Company ( 1 )
Name
Company
Email
Phone
Company ( 2 )
Name
Company
Email
Phone
Company ( 3 )
Name
Company
Email
Phone
Authorization
“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, anything falsified on this application shall be grounds for termination. I authorize investigation of all statements contained, the references and employers listed above to give you any and all information concerning my previous employment. I also understand and agree that no representative of the company has any authorization to enter into any agreement for employment for any specified period of time, or to make any agreement contrary foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws”
Signature
Date
Submit
