EMPLOYMENT APPLICATION

Most Recent Employer Information
Please tell us about your most recent employer.
Employer
Phone Number
Supervisor
City
State
Duties
Pay Rate
Reason for Leaving
Second Most Recent Employer
Please tell us who you worked for before your most recent employer.
Employer
Phone Number
Supervisor
City
State
Duties
Pay Rate
Reason for Leaving
Emergency Contact
Name
First Last
Please list two people for personal references:
(Please list responsible people who have knowledge of your character, experience, and ability. Do NOT include relatives or former employers).
First Reference Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Occupation
Years Known
Second Reference Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Occupation
Years Known

The facts set forth in this application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal without notice, if and when discovered. I authorize investigation and verification of all statements contained in this application for employment. I authorize the references listed on this application to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. Further, I agree to take a physical examination, if required, and recognize that any offer of employment may be contingent upon the results of such an examination.
Please check that you have read the above statement.
Today's Date
MM slash DD slash YYYY

Employment Application at Evergreen