Date:         Position Applied For: Telemarketer Loan Officer Processing/Administration Other

Applicant Data

Name:         Last:     First:     Middle:

Address:     City:     State:     Zip:

Phone:     Other Phone:     E-Mail:

Date Available to Start:     Social Security #:     Salary Requirements:

If you are under 18 and we require a work permit, can you furnish one?     Yes    No    N/A

If No, please explain:

Have you ever worked for this company?     Yes    No        If yes, When?

Are you a citizen of the United States?    Yes    No        If not, are you legally allowed to work in the United States? Yes    No

Type of employment desired:    Full-time    Part-Time    Temporary    Seasonal

Have you ever pled "guilty," "no contest," or been convicted of a crime?     Yes    No

If yes, give dates and details:

Answering "yes" to these questions does not constitute an automatic rejection for employment.  Date of the offense, seriousness, and nature of the violation, rehabilitation, and position applied for will be considered.

Do you have reliable transportation?     Yes    No

Who referred you to us?

Education

High School:     Address:

# of Years Completed:     Did you Graduate?    Yes    No

GPA:     Class Rank:

College:     Address:

# of Years Completed:     Did you Graduate?    Yes    No    Degree:

Major:     GPA:     Class Rank:

Other:     Address:

# of Years Completed:     Did you Graduate?    Yes    No    Degree:

Major:     GPA:     Class Rank:

References   

Please furnish the names, address, and telephone numbers of two people to whom you are not related and by whom you have not been employed.

Name:     Phone:

Address:     City:     State:     Zip:

Name:     Phone:

Address:     City:     State:     Zip:

Summarize Special Skills or Qualifications

Previous Employment

Begin with the most recent.

Dates of Employment:    From: To:         Position (s) Held:

Firm:     Address:

Phone:     Supervisor:      Title:

Responsibilities:

Starting Salary and Title:        Ending Salary and Title:

Reason for Leaving:

My we contact this employer for a reference?    Yes    No

 

Dates of Employment:    From: To:         Position (s) Held:

Firm:     Address:

Phone:     Supervisor:      Title:

Responsibilities:

Starting Salary and Title:        Ending Salary and Title:

Reason for Leaving:

My we contact this employer for a reference?    Yes    No

 

Dates of Employment:    From: To:         Position (s) Held:

Firm:     Address:

Phone:     Supervisor:      Title:

Responsibilities:

Starting Salary and Title:        Ending Salary and Title:

Reason for Leaving:

My we contact this employer for a reference?    Yes    No

I certify that my answers are true and complete to the best of my knowledge.  I authorize you make such investigations and inquires of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision.  I hereby release employers, schools, or persons from all liability when responding to inquires in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview (s) may result in discharge.

I certify that my answers are true and complete to the best of my knowledge. I authorize you make such investigations and inquires of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools, or persons from all liability when responding to inquires in connection with my application. In the event I am employed, I understand that false or misleading information given in my application or interview (s) may result in discharge.

Yes    No        Initials: