Employment Application - Jordan's Building Center, Inc.

Personal Information

Date*

Social Security Number

Name*

First Middle Last

Present address*

Street Address City State ZIP Code

Permanent address*

Street Address City State ZIP Code

Phone*

Are you 18 years or older?*

Yes

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?*

Yes

Employment Desired

Position*

Date you can start*

Salary desired*

Are you employed now?*

Yes

If so may we inquire of your present employer?

Yes

Ever applied to this company before?*

Yes

Where?

When?

Referred by

Education

Name and Location of School

No. of years attended

Did you graduate?

Subjects studied

Grammar School

Grammar school name and location

Grammar school no. of years attended

High School Did you graduate

Yes

Grammar School Subjects Studied

High School

High school name and location

High school no. of years attended

High School Did you graduate

Yes

High School Subjects Studied

College

College name and location

College no. of years attended

College Did you graduate

Yes

College Subjects Studied

Trade, Business or Correspondence School

Trade name and location

Trade no. of years attended

Trade Did you graduate

Yes

Trade Subjects Studied

General

Subject of special study or research work

Special skills

Activities: (civic, athletic, etc)

Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members.

U.S. Military or Naval service

Yes

Rank

Present membership in National Guard or Reserves

Yes

Former employers

List below last three employers, starting with the last one first.

Date month and year

Name and address of employer

Salary

Position

Reason for leaving

Date month and year

Name and address of employer

Salary

Position

Reason for leaving

Date month and year

Name and address of employer

Salary

Position

Reason for leaving

Date month and year

Name and address of employer

Salary

Position

Reason for leaving

Which of these jobs did you like best?

What did you like most about this job?

References

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

Name

Address

Business

Years acquainted

Name

Address

Business

Years acquainted

Name

Address

Business

Years acquainted

Name

Address

Business

Years acquainted

The following statement applies in: Maryland & Masschussetts. (Fill in name of state.)
It is unlawful in the state of

Unlawful state

to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Signature*

In case of emergency notify

Name

Address

Phone No.

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.
My employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than it’s president, and then only when in wrong and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

Date*

Signature*

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