PERSONAL INFORMATION |
First Name:* |
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Middle Name: |
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Last Name:* |
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Present Address: |
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Present City: |
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Present State: |
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Present Zip: |
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Permanent Address: |
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Permanent City: |
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Permanent State: |
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Permanent Zip: |
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Phone Number:* |
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Email Address:* |
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Are you at least 18 years or older?* |
Yes No
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Name and relationship of any relatives in our employ |
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Referred by: |
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EMPLOYMENT DESIRED
The Bemidji Town & CC is currently taking applications for all positions, and they will be on file for 6 months.
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Position:* |
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Date you can start: |
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Salary/Wage Desired: |
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Are you currently employed? |
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May we contact your employer? |
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Have you ever applied with us before? |
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If so, when? |
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EDUCATION |
Subjects of special study or research work: |
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Special training: |
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Activities: (civic, athletic, etc) |
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Exclude organizations, the name or character of
which indicates the race, creed, sex, marital status, age, color or national origin of it's members |
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FORMER EMPLOYERS
List your last four employers, starting with present or most recent |
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Employer 1 |
Start Date/End Date: |
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Name and Address of Employer: |
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Salary/Wage: |
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Phone: |
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Position: |
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Reason for leaving: |
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Employer 2 |
Start Date/End Date: |
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Name & Address of Employer: |
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Salary/Wage: |
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Phone: |
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Position: |
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Reason for leaving: |
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Employer 3 |
Start Date/End Date |
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Name & Address of Employer: |
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Salary/Wage: |
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Phone: |
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Position: |
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Reason for leaving: |
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Employer 4 |
Start Date/End Date: |
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Name & Address of Employer: |
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Salary/Wage: |
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Phone: |
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Position: |
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Reason for leaving: |
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REFERENCES
Give the names of 3 persons not related to you, whom you have known at least one year. |
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Reference 1 |
Name: |
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Address: |
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Phone: |
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Business: |
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Years acquainted: |
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Reference 2 |
Name: |
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Address: |
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Phone: |
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Business: |
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Years acquainted: |
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Reference 3 |
Name: |
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Address: |
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Phone: |
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Business: |
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Years acquainted: |
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IN CASE OF EMERGENCY, NOTIFY: |
Name: |
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Address: |
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Phone: |
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OTHER |
Comments |
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As part of our procedure for processing your application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged.
You may make a written request for information derived from the checking of you references.
I understand and agree to the information shown above.
Please Check this Box:
I authorize
investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called
for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless
of the date of payment of my wages and salary, be terminated at any time without any previous notice.
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