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APPLICATION FOR EMPLOYMENT

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 795 Greenville Pike

PO Box 686

Clarion, PA 16214

 

  Applicant Information      
Full Name: Date:  
  Last First FULL MIDDLE NAME
Address:
  Street Address Apartment/Unit #                                                               Drivers license #
 
  City State ZIP Code
Phone: E-mail Address:
Date Available: Social Security No.:  Desired Salary:  $
Position Applied for: Date of Birth:       
Are you a citizen of the United States?

YES

 

NO

 

If no, are you authorized:  

YES

   

NO

 
Have you ever worked for this company?

YES

   

NO

 

If yes, when?  
Have you ever been convicted of a felony?

YES

   

NO

 

If yes, explain:  
  Education  
High School: Address:

From:

 To:   Did you graduate?

YES

 

NO
 

Degree:

 
College: Address: 

From:

To:

   Did you graduate?

YES

 

NO

 

 

Degree:

 
Other: Address: 

From:

 To:     Did you graduate?

YES

 

NO
 

Degree:

 
  Please list three professional references.  
Full Name: Relationship:
Company: Phone:
Address  
Full Name: Relationship:
Company: Phone:
Address:  
Full Name: Relationship:
Company: Phone:
Address:  
  Previous Employment  
Company: Phone:
Address: Supervisor:
Job Title: Starting Salary:  $  Ending Salary:  $ 
Responsibilities:  

From:

To:   Reason for Leaving:
  May we contact your previous supervisor for a reference?

YES

NO

 

Company: Phone:
Address: Supervisor:
Job Title: Starting Salary:  $  Ending Salary:  $
Responsibilities:  

From:

 To:   Reason for Leaving:
  May we contact your previous supervisor for a reference?

YES

 

NO

 

Company: Phone:
Address: Supervisor:
Job Title: Starting Salary:  $ Ending Salary:  $
Responsibilities:  

From:

To:   Reason for Leaving:
  May we contact your previous supervisor for a reference?

YES

NO

 

  Military Service  
Branch: From: To:
Rank at Discharge: Type of Discharge:
If other than honorable explain:  
     
I certify that my answers are true and complete to the best of my knowledge.

 

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

 

  
Signature: Date:
   
  Disclaimer: "Email is not considered to be a completely secure medium for the transmission of sensitive information. Those who email credit application information do so at their own risk."
 		  

 

 

 
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Zacherl Motor Truck Sales - PO Box 686 - 795 Greenville Pike - Clarion, PA 16214 - 1-800-832-8580