Job Application

HG Page & Sons, Inc Employment Application

Name
FirstLast
Date
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Email
Date Available
Social Security Number
Desired Salary
Position Applied For
Are you a citizen of the United States?
- Yes
- If no, are you authorized to work in the U.S?
Have you ever worked for this company?
- Yes
- No
If so, when?
Name of any relative working at Page
Are you currently working?
- Yes
- No
If no, are you on a leave of absence or laid off?
How many days of work have you missed in the past 12 months due to illness or other cuases?
Have you ever been fired?
- Yes
- No
Do you have a valid New York State drivers license?
- Yes
- No
Drivers Identification No.
Do you have any physical conditions that limit or prevent you from engaging in strenuous activities?
- Yes
- No
If yes, how could Page accommodate your condition on the job?
Have you ever been convicted of a felony or misdemeanor? • Answering "yes" will NOT automatically disqualify you from employment.
- Yes
- No
List Offense(s)
High School
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
From
MM
DD
YYYY
To
MM
DD
YYYY
Did you graduate?
- Yes
- No
Did you receive?
- Degree
- GED
College
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
From
MM
DD
YYYY
To
MM
DD
YYYY
Did you graduate?
- Yes
- No
Other
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
From
MM
DD
YYYY
To
MM
DD
YYYY
Did you graduate?
- Yes
- No
Branch
From
MM
DD
YYYY
To
MM
DD
YYYY
Rank at Discharge
Type of Discharge
If other than honorable, please explain
Company
Phone
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM
DD
YYYY
To
MM
DD
YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Company
Phone
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
MM
DD
YYYY
To
MM
DD
YYYY
Reason for Leaving
May we contact your previous supervisor for a reference?
- Yes
- No
Explain reasons for inactivity between this present application and prior work
References
FirstLast
Relationship
Company
Phone
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Name
FirstLast
Relationship
Company
Phone
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Name
FirstLast
Relationship
Company
Phone
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Check areas in which you have skills or knowledge
- Cash Register
- Computer
- Word Processor
- Typing
- WPM
- Lumber
- Power Tools
- Hardware
- Paint
- Plumbing
- Electrical
- Waterhousing
- Forklift
Other
Name
FirstLast
Date
Pre-Employment Reference Request
Employment References
Name
FirstLast
Company
Phone
Name
FirstLast
Company
Phone
Name
FirstLast
Company
Phone
Personal Reference
Name
FirstLast
Relation
Phone
Name
FirstLast
Relation
Phone
Name
FirstLast
Relation
Phone
I give H.G. Page & Sons Permission to Check My References to determine employment eligibility.
Important Disclaimer Please Read the Following:
The information given in this application is true in all respects. I agree if the information is found to be false in any respect, including the omission of information, I will be subject to dismissal, without notice, at any time. I authorize you to investigate all information in this application. I hereby authorize my former employers to release information pertaining to my work record, habits and performance. I hereby authorize H.G. Page & Sons to obtain a background investigative report made by a security or consumer, reporting agency in respect to me. In so doing, I release the reporting agency, H.G. Page & Sons and its agents from any and all liability, which may flow from the release of such information. I understand any employment will be on a 90-day introductory basis and that my employment may be terminated, with or without cause or notice, at any time, at my option or that of this company. I understand that no management representative has any authority to enter into any agreement for continuing employment for any specific period of time, which is contrary to the forgoing without written approval of the company president. I further understand that before any offer of employment is finalized I will be required to submit blood, urine or other medical testing for alcohol, drugs and controlled substances at a company-selected medical facility at the company’s expense. If the test results demonstrate the presence of undisclosed prescribed or unauthorized controlled substance or an unacceptable level of alcohol, I understand that I will not be permitted to commence work for the company. I voluntarily consent for the designated medical facility to collect urine and blood samples from me and to test for the presence of alcohol, drugs and controlled substances. Further, the medical facility is authorized to release the results of the test to H.G. Page & Sons. H.G. Page & Sons is authorized to communicate the test results internally as it deems appropriate. I may request a copy of this authorization. We are an equal opportunity employer.
Name
FirstLast
Date
Notes
If you have one, you may attach a resume.