Employment

Have you ever been employed at Chuck's Furniture?

Yes No

If so, when?

Name of last supervisor?

Who referred you to this company?

Employment Agency Newspaper Advertisement Friend State Employment Office College Placement Office Web Site Other

Education

Select you highest level of education completed

GED High School Some College Technical / Trade School Associates Degree Bachelors Degree Masters Degree

High School Attended*

College Attended

Other graduate, business, or vocational school, or other training skills

General

Subjects of special study or research work

Special training

Special skills

Employment Information

Name of Employer*

Employer Address*

Employer Phone*

Dates of employment. From*

To*

Starting Wage

Type of Business*

Ending Wage*

Your Position/Title*

Supervisor*

Briefly describe your duties and responsibilities*

Name of Employer

Employer Address

Employer Phone

Dates of employment. From

Starting Wage

Type of Business

Ending Wage

Your Position/Title

Supervisor

Briefly describe your duties and responsibilities

Name of Employer

Employer Address

Employer Phone

Dates of employment. From

Starting Wage

Type of Business

Ending Wage

Your Position/Title

Supervisor

Briefly describe your duties and responsibilities

Service Record

Branch of service

Discharge date

Rank

Have you been convicted of a felony within the last five year?

Yes No

If yes, please explain (this will not necessarily exclude you from consideration)

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, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative from the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

Authorized

Yes, process my application. No, do NOT process my application.

Please type your name in the signature box below:*

Application for Employment

Questionnaire

Education

General

Employment Information

Service Record

Authorization