RESIDENTIAL  |  COMMERCIAL  |  INDUSTRIAL  |  GRADING
(276) 694-7158    |    info@clarkbrotherscompany.com

EMPLOYMENT APPLICATION

Personal Information

FIRST NAME MIDDLE LAST SS#
PRESENT ADDRESS CITY STATE ZIP
PERMANENT ADDRESS CITY STATE ZIP
PHONE # SECONDARY PHONE # REFERRED BY

Employment Desired

POSITION DATE YOU CAN START SALARY DESIRED
ARE YOU
EMPLOYED NOW?
YES NO IF SO, MAY WE INQUIRE OF
YOUR PRESENT EMPLOYER?
YES NO ARE YOU LEGALLY AUTHORIZED
TO WORK IN THE U.S.?
YES NO
EVER APPLIED TO
THIS COMPANY BEFORE?
YES NO WHERE WHEN

Education History

HIGH SCHOOL YEARS ATTENDED DID YOU GRADUATE? YES NO SUBJECTS STUDIED
COLLEGE YEARS ATTENDED DID YOU GRADUATE? YES NO SUBJECTS STUDIED
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL YEARS ATTENDED DID YOU GRADUATE? YES NO SUBJECTS STUDIED

General Information

SUBJECT OR SPECIAL STUDY/RESEARCH WORK
SPECIAL TRAINING
SPECIAL SKILLS
U.S. MILITARY OR NAVAL SERVICE RANK

Former Employers (List Below Last Four Employers, Starting With Last One First)

FROM TO NAME & ADDRESS OF EMPLOYER
SALARY POSITION REASON FOR LEAVING PHONE
#
FROM TO NAME & ADDRESS OF EMPLOYER
SALARY POSITION REASON FOR LEAVING PHONE
#
FROM TO NAME & ADDRESS OF EMPLOYER
SALARY POSITION REASON FOR LEAVING PHONE
#
FROM TO NAME & ADDRESS OF EMPLOYER
SALARY POSITION REASON FOR LEAVING PHONE
#

References (GIve Below The Names Of Three Persons Not Related To You, Whom You Have Known At Least One Year)

NAME ADDRESS PHONE # BUSINESS YEARS KNOWN
NAME ADDRESS PHONE # BUSINESS YEARS KNOWN
NAME ADDRESS PHONE # BUSINESS YEARS 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 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 representitive.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilies Act (ADA) and other relevant federal and state laws."


I have read and agree to the above terms and conditions.
Clark Brothers Company, Inc.     P.O. Box 267   •   Stuart, VA 24171 Like us on Facebook