If you are interested please fax your application to: 317-248-9190 or send it via e-mail to Tammy: firstname.lastname@example.org
APPLICATION FOR EMPLOYMENT
Years Date Subjects
Name and Location of School Attended* Graduated* Studied
or Correspondence School
*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.
Subjects of special study or research work
What foreign languages do you speak fluently?
U.S. Military or Naval service?
Present membership in the National Guard or Reserves?
Do you have any physical defects that preclude you from performing any work for which you are being considered?
Were you ever injured?
Have you any defects in hearing?
In cases of emergency notify:
List below last four employers, starting with last one first
Date, Name and Address Reason for
Month and Year of Employer Salary Position Leaving
Give below the names and addresses of three persons, not related to you, whom you have known at least one year.
Name Address Business Known
I authorize investigation of all statements contained in the application. I understand that misrepresentation or omission of facts called for is cause for dismissal, further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.
Date _____________________ Signature__________________________________________________