Employment Application

PLEASE READ CAREFULLY
Note: Fields marked with a * require an answer. Please use "N/A" for "not applicable" if necessary. Applicants may be required to complete and sign a paper application for employment upon interview.

Attach Resume:	(pdf, doc, docx)
*Email:
Applying for:

Applicant Information

Education

High School:		Address:
Graduate:	Yes No	Degree:
College:		Address:
Graduate:	Yes No	Degree:
Other:		Address:
Graduate:	Yes No	Degree:

References

Please list three references not related to you, whom you have known at least one year.
Name:		Occupation:
Company:		Day Phone Numbers:
Address:
Name:		Occupation:
Company:		Day Phone Numbers:
Address:
Name:		Occupation:
Company:		Day Phone Numbers:
Address:

Employment History

Company Name:	Complete Address (w/ City, State, Zip):
Phone:	Supervisor:
Job Title:	Responsibilities:
Starting Salary:	Ending Salary:
Start Date: (mm/dd/yyyy)	End Date: (mm/dd/yyyy)
Reason for Leaving:	May we contact your previous employer for a reference?	Yes No

Military Service

Start Date: (mm/dd/yyyy)		End Date: (mm/dd/yyyy)
Branch:		Rank at Discharge:
Type of Discharge:		If other than honorable, explain:

Applicant's Statement

Notification and Agreement

I hereby affirm that all information in this application is true and accurate to the best of my knowledge. I understand that the college can obtain criminal history record information on applicants for employment. Pursuant to the requirements of the Fair Credit Reporting Act, notice is given that a consumer report+ may be made in connection with your application for employment. I understand that any misrepresentation or falsification of this record or failure to disclose conviction for a felony or for any offense involving moral turpitude will be considered cause for dismissal.

If you are denied employment, either wholly or partly, because of information contained in a consumer report, a disclosure will be made to you of the name and address of the consumer-reporting agency making such report.

Signature below verifies you have read the above notice and understand what it means.

*First Name:		*Last Name:
MI:
*Address:		Apartment/Unit #
*City		*State
*Zip
*Phone:		Referred By:
Date Available:		Salary Expected:
I can work:	Weekends Evening Night
U.S. Citizen:	Yes No	If not, are you authorized to work in the U.S.?:	Yes No
Languages Spoken:
*Have you ever worked for this company?:	Yes	No
If yes, when?:		------ To ------
*Have you ever been convicted of a felony? (By company policy some misdemeanors may bar employment):	Yes	No
If yes, explain briefly:
*Driver's License Number		*State Issued
*License Class		*Valid

(432) 999-8704 | sales@southernconnections.com

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