PERSONAL INFORMATION

PRESENT ADDRESS
PERMANENT ADDRESS
ARE YOU 18 YEARS OR OLDER?
YesNo
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?

YesNo
EMPLOYMENT DESIRED:
ARE YOU EMPLOYED NOW?
YesNo
IF SO MAY WE CONTACT YOUR CURRENT EMPLOYER?

YesNo

EVER APPLIED TO THIS COMPANY BEFORE?
EDUCATION
NAME AND LOCATION OF SCHOOL
*NO OF YEARS ATTENDED
*DID YOU GRADUATE?
SUBJECTS STUDIED
GRAMMAR SCHOOL
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL
GENERAL

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK

FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST).
DATE MONTH AND YEAR
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
FROM
TO
FROM
TO
FROM
TO
WHICH OF THESE JOBS DlD YOU LIKE BEST?
WHAT DlD 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

IN CASE OF EMERGENCY NOTIFY
"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.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT

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.

DO NOT WRITE BELOW THIS LINE
HIRED:YesNo
APPROVED:
This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.