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Personnel Application Form for
Employment @ NJ & Associates, Inc. |
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Federal, State and local laws prohibit discrimination in
employment because of sex, age, race, color, religious creed,
citizenship, marital status, national origin, ancestry, unfavorable
discharge from military service or non-impairing physical handicap or
disability. |
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PERSONAL |
| Name: |
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First Middle Initial Last
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| Social Security No: |
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| Address: |
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City State Zip
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| Phone: |
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Home Work Ext Cell Fax |
| Email: |
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If Under 18
years of age, do you have a valid work permit?
Yes
No |
Have you any
relatives employed by this company?
If Yes, give the name of employee: |
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How were you
referred to the company?
Agency Ad
Employee Referral
Other
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If Employee
referral, please give the name of employee: |
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If Other, please
specify: |
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If employed @NJ
& Associates before, please give details: |
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When: |
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Where: |
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Under what name, if
different from above: |
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Are you either a citizen of the united states or a
legal alien, who has the right to remain permanently and work in the
United States? (You will be required to produce proof of your right to
work following a conditional offer of employment.):
Yes
No |
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EMPLOYMENT OBJECTIVES |
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Position Desired: To select more than one position, please select one
and then select subsequent ones while pressing Ctrl button on your
Keyboard.
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Full Time Or Part Time:
Full-time
Part-time
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Preferred
Geographical Location: |
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Willing to Travel: Yes
No
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Willing to Relocate: Yes
No |
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Date Available to
start work: |
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Expected Salary
amount (Approx.): |
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Employment History |
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Present or Last Employer |
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Present or Last
Employer: |
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Employer Address: |
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Title: |
Nature Of Duties:
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Employment Period:
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Start Date End Date
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Base Salary or Wage:
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Start End or Current
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Supervisor's Name
and Title: |
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Supervisor's Phone:
Ext: |
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Reason for Leaving: |
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Permission to
contact employer for reference:
Yes
No |
| Previous
Employer |
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Previous Employer: |
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Employer Address: |
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Title: |
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Nature of Duties: |
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Employment Period:
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Start Date End Date
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Base Salary or Wage:
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Start End or Current
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Supervisor's Name
and Title: |
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Supervisor's Phone:
Ext: |
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Reason for Leaving: |
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Permission to
contact employer for reference:
Yes
No |
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Additional Previous Employers |
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Please account for any break in employment over 30 days. |
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Employment Company and Address Title or Base Salary Reason
Dates Type Of
Work for Leaving |
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To |
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EDUCATION |
School Attended
Name
City, State, Zip Major course Highest Level
Degree
Of
Study Completed |
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High School
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College
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Grad School |
Business or
Trade School |
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List any Business skill or special training you have: |
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Indicate your Professional designation (s) or other
certification (s), if any: To select more than one , please select one
and then select subsequent ones while pressing Ctrl button on your
Keyboard.
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Other
Certifications: |
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Choose one or more specialty (s) that would best
match your experience: To select more than one , please select one
and then select subsequent ones while pressing Ctrl button on your
Keyboard.
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Notes: Please state any additional information which you
feel would be helpful to us in considering your application. do not list
any information which would indicate your age, race, color, sex,
religion, marital status, national origin, military status, citizenship
or disability. |
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By submitting this application form, you authorize any
organization affiliated with NJ & Associates, Inc. to make any
investigation of your background deemed necessary. You further authorize
all persons, schools, companies, corporations, credit bureaus, and law
enforcement agencies to supply all information concerning your
background and to furnish reports thereon and you release them and any
organization affiliated with NJ & Associates, Inc. from any
and all liability and responsibility arising from their doing so.
It is understood that, in making the application for
employment, an investigation may be made whereby information is obtained
through personal interviews with your neighbors, friends, or others with
whom you are acquainted. This inquiry includes information as to your
character, general reputation, personal characteristics and mode of
living. You have the right to make a written request within a reasonable
period of time for a complete and accurate disclosure of additional
information concerning the nature and scope of this investigation.
You agree to conform to the rules and regulations of the
company. Your employment may be terminated, at any time, at the option
of the company or yourself.
You certify that the answers given to all questions on
this application and any attachments are to the best of your knowledge
and belief true and correct and that you have not knowingly withheld any
pertinent facts or circumstances. You understand that any omission or
misinterpretation of fact in this application may result in refusal of
or separation from employment upon discovery thereof. |
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Applicant's Signature and Date : |
