Application for Employment - Spencer Management Inc.

Personal Information

Date

Name

First Last

Present Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Permanent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Referred By

First Last

Employment Desired

Position

Date You Can Start

Salary Desired

Are you employed now?

Yes
No

Are you legally authorized to work in the U.S.A.?

Yes
No

Criminal History

Yes
No
Will Explain

Ever applied to this company before?

Yes
No

If yes, where?

If yes, when?

Education

High School

Name & Location of School	Years Attended	Did you graduate?	Subjects Studied

College

Name & Location of School	Years Attended	Did you graduate?	Subjects Studied

Trade, Business or Correspondence School

Name & Location of School	Years Attended	Did you graduate?	Subjects Studied

General Information

Subjects of Special Study or Research Work

Special Training

Special Skills

U.S. Military Service / Rank

Former Employers

Begin with most recent employer

Date, Month and Year (From - To)	Name & Address of Employer	Salary	Position	Reason for Leaving

Click the + button to the right to add more employers.

References

Give below the names of three persons not related to you, whom you have known at least one year.

Name	Phone	Business	Years Known

Click the + button to the right to add more references.

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 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 representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Electronic Signature

First Last

Date

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Phone

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