*Please note: The position you apply for may require lifting
up to fifty pounds!*
FORMER EMPLOYERS List the last four employers starting with the most recent.
Start:
End:
Name & Address
Supervisor/PH. No.
Wage/Position
Reason for Leaving
Start:
End:
Name & Address
Supervisor/PH. No.
Wage/Position
Reason for Leaving
Start:
End:
Name & Address
Supervisor/PH. No.
Wage/Position
Reason for Leaving
Start:
End:
Name & Address
Supervisor/PH. No.
Wage/Position
Reason for Leaving
REFERENCES (3)
Name
Address
Business
Years Known
Skills, Organization, Memberships, Hobbies:
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 that may result from utilization of such information. I also understand
and agree that no representative of 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 representatives.
