HELP WANTED:
Bootheel Youth Museum
Application for Employment
Name SS# _________________
Last First MI
Present Address___________________________________________________________
Home Phone ( )_____________ Emergency Phone ( )_______________
Cell Phone ( ) ______________ Email Address _______________________
Date of Birth ___/ ___/ _____ To Days Date ___/___/_____
Are you either a US citizen or an alien authorized to work in the United States? Yes No
EDUCATION
School
Graduated
Year Grad
Type of Degree
Grammar
Y N
High School
Y N
College
Y N
Other
Y N
EMPLOYMENT HISTORY
(List your last three employers, starting with the most recent first.)
Month and Year for Each
Name and Address of Employer
Salary
Position
Reason for Leaving
From
To
From
To
From
To
Have you ever been convicted of a felony or a misdemeanor?* Yes___ No___
If Yes, please describe:_____________________________________________________
________________________________________________________________________________________________________________________________________________
*You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.
(CONTINUED)
REFERENCES
(Give the names of three persons, not related to you, whom you have known at least one year.)
NAME and ADDRESS
PHONE
OCCUPATION
EMPLOYMENT DESIRED
Position________________ Salary Desired __________ Date Available to Start_______
Are you employed now? ______ If so, may we inquire of your present employer? ______
Date and Time Available
Monday
Friday
Tuesday
Saturday
Wednesday
Sunday
Thursday
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 listed above to give you any and all information concerning my previous employment and any 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.
I understand and agree that, if hired, 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 prior notice.
I understand that, if hired, I may be subject to drug test administered through a third party commissioned by the Museum.
SIGNATURE___________________________ DATE__________________
FOR OFFICE USE ONLY
INTERVIEW DATE / / _ POSITION HIRED FOR
HIRING DATE / / _ TERMINATION DATE / / _
TRAINING DATES / / _, / / _, / / _, / / _
RECEIVED POLICIES and JOB DESCRIPTIONS: Yes / No Date: / / _
Revised 9/10/15 |
