APPLICATION FOR EMPLOYMENT EQUAL OPPORTUNITY EMPLOYER Personal Information Name Date MM slash DD slash YYYY Social Security No. Present Address Street Address City State / Province / Region ZIP / Postal Code Permanent Address Street Address City State / Province / Region ZIP / Postal Code PhoneReferred By Employment Desired Date MM slash DD slash YYYY Salary desired Are you employed now? Yes No Are you legally authorized to work in the USA? Yes No Ever applied to this company before? Yes No Where? When? EducationName & Location of School High School Did you graduate? Subjects studied Name & Location of School Years attended Did you graduate? Subjects studied Name & Location of School Years attended Did you graduate? Subjects studied General InformationSubjects of special study or Research Work Special Training Special Skills US Military ServicesRankFormer Employers Begin with most recent employerDate, Month & YearName & Address of EmployerSalaryPositionReason for leaving References Given Below The Names Of The Three Not Related To You, Whom You Have Known At Least One Year NameTelephoneProfessionYears Known 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." Date Signature DO NOT WRITE BEYOND THIS LINEInterviewed By Date REMARKSHiredFor Dept.PositionWill ReportSalary WagesApproved: 1.Employment Manager 2.Department Head 3.General Manager This application for employment is sold only for general use throughout the United States. Tops Products assumes no responsibility and hereby disclaims any liability for the inclusion in this form of any questions or requests for information upon which a violation of local, state, and/or federal law may be based. It is the user's responsibility to ensure that this form's use complies with applicable laws, which change from time to time. Δ SOLICITUD DE EMPLEO IGUALDAD DE OPORTUNIDADES EN EL EMPLEO Informacion Personal Nombre Fecha MM slash DD slash YYYY No De Seguro Social Direccion Actual Dirección Ciudad Stado Codigo Postal Direccion Permanente Direccion Ciudad Stado Codigo Postal TelefonoRecomendado Por Empleyo Deseado Fecha Que Puede Empezar MM slash DD slash YYYY Salario deseado ¿Trabaja Actualmente? Si No ¿Esta Autorizado Para Trabajar Legalmente En EE.UU? Si No ¿A Postulado A Esta Compa--iA Antes? Si No ¿Donde? ¿Cuando? EducaciónNombre Y Lugar De La Escuela Escuela Segundaria Se Graduado? Ramos Estudiados? Nombre Y Lugar De La Escuela A--Os Que Asistio Se Graduado? Ramos Estudiados? Nombre Y Lugar De La Escuela A--Os Que Asistio Se Graduado? Ramos Estudiados? Información generalEstudio Especial O Trabajo De Investigacion Capacitacion Especial Aptitudes Especiales Servicio Militar (EE.UU)RangoEmpleadorers AnterioresFecha, Mes Y A--ONombre Y Direccion Del EmpleadorSalarioPuestoRazon De Salida Referencias Referencias De El Nombre De Tres Personas Que No Sean Sus Parientes, Y A Quines Conozca Al Menos Un Ano NombreTeléfonoProfesiónA--Os Que Lo Conoce Autorización"Certifico que los datos contenidos en esta solicitud son a mi mejor saber y entender verdaderos y completos, y entiendo que si me emplean, las declaraciones falsas contenidas en esta solicitud seran causal de despido. Autorizo que se indaguen todos los datos, las referencias y los empleadores contenidos en esta solicitud, con el fin de recabar informacion relativa a mis empleos anteriores, y toda la informacion pertinente, personal o de cualquier otro tipo, que los mismos pudieran aportar, y libero a la compania de cualquier responsabilidad por cualquier deo que pudiera resultar por la utilizaciOn de dicha informaciOn. Tambien entiendo y acepto que ningt:m representante de Ia compania esta facultado para hacer un contrato por atgun period° determinado, ni para hacer un contrato contrario a to precedente, a menos que el mismo sea por escrito y firmado por un representante autorizado de Ia compania. Esta denegaciOn no permite Ia divulgacion ni el use de informacion medica o relacionada con discapacidades, tal como lo establece la ADA (Ley de Estadounidenses con Discapacidades) y otras leyes federates y estatales pertinentes."Fecha Firma NO ESCRIBA DEBAJO DE ESTA LINEAInterviewed By Date RemarksHiredFor Dept.PositionWill ReportSalary WagesApproved: 1.Employment Manager 2.Department Head 3.General Manager This application for employment is sold only for general use throughout the United States. Tops Products assumes no responsibility and hereby disclaims any liability for the inclusion in this form of any questions or requests for information upon which a violation of local, state, and/or federal law may be based. It is the user's responsibility to ensure that this form's use complies with applicable laws, which change from time to time. Δ
