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Steven DiFranco Inc. Employment Application
Steven DiFranco Inc. is an equal oppourtunity employer Steven DiFranco Inc. is an "employment at will" corporation This application is not an employment agreement
Last Name: _______________________________ First Name: _____________________ Initial: ________ Present Street Address: _________________________________________________________________ City: __________________________________ State: ______________________ Zip: ______________ Home Phone: ________________________________ Cell: ____________________________________ Social Security #: _________________________________ Date of Birth: __________________________ In case of emergency notify: Name: ________________________________________________________ Street: ________________________________________________________ City, State, Zip: ________________________________________________________ Telephone: ________________________________________________________ Are you a citizen of the United States: Yes _______ No _________ If not, which country are you a citizen of: ________________________________________________________ Are you able to be legally employed in this country: Yes ___________ No __________ Do you speak a foreign language: Yes ________ No ______________ Which language? ________________ What are your hobbies?: ______________________________________________________________________ Have you ever been in the military? Yes _________ No ___________ Are you currently in the National Guard? Yes _________ No _________ Date you can start work: ______________________________________ Employment History Current Employer Name: _____________________________________________________________________ Address: __________________________________________________________________________________ City, State, Zip: _____________________________________________________________________________ Phone: __________________________________________________________________________________ Salary/Wage at this employer: _______________________________________________________________ How long employed at this company: __________________________________________________________ Reason for leaving this company/job: __________________________________________________________ Can we contact this previous employer?: Yes __________ No ____________ Who should we speak with about your employment: ______________________________________________ If no, why? _______________________________________________________________________________
Previous Employer Name: ___________________________________________________________________ Address: _________________________________________________________________________________ City, State, Zip: _____________________________________________________________________________ Phone: ___________________________________________________________________________________ Salary/Wage at this employer: ________________________________________________________________ How long employed at this company: ___________________________________________________________ Reason for leaving this company/job: ___________________________________________________________ Can we contact this previous employer?: Yes __________ No ____________ Who should we speak with about your employment: ______________________________________________ If no, why? ________________________________________________________________________________
Previous Employer Name: ______________________________________________________________________ Address: ___________________________________________________________________________________ City, State, Zip: ______________________________________________________________________________ Phone: ____________________________________________________________________________________ Salary/Wage at this employer: _________________________________________________________________ How long employed at this company: ____________________________________________________________ Reason for leaving this company/job: _________________________________________________________ Can we contact this previous employer?: Yes __________ No ____________ Who should we speak with about your employment: _____________________________________________ If no, why? ______________________________________________________________________________ Education History High School Name: ___________________________________________________ Graduated: Yes ________ No __________ Sports/Activities: __________________________________________________________________________ College Name: ____________________________________________________________________________ Graduated: Yes _________ No __________ Sports/Activities: __________________________________________________________________________
Have you ever been convicted of a felony in the last 7 years? Yes _________ No _________
Please note that a conviction will not necessarily disqualify an applicant from employment Personal References
#1 Name: _______________________________________________________________________________ Address: ________________________________________________________________________________ City, State, Zip: ___________________________________________________________________________ Telephone: ______________________________________________________________________________ How do you know this person? _______________________________________________________________
#2 Name: ______________________________________________________________________________ Address: _______________________________________________________________________________ City, State, Zip: __________________________________________________________________________ Telephone: _____________________________________________________________________________ How do you know this person? _____________________________________________________________
#3 Name: ______________________________________________________________________________ Address: _______________________________________________________________________________ City, State, Zip: _________________________________________________________________________ Telephone: ____________________________________________________________________________ How do you know this person? _____________________________________________________________
Do you have any pre-scheduled vacations, trips, plans that we should know about? Yes _____ No _____ If so, when? _____________________________________________________________________________ ________________________________________________________________________________________ Interviewer: _________________________________________________ Date: ___________________ Interviewer notes: _______________________________________________________________________ _______________________________________________________________________________________
The job you are applying for can involve, but is not limited to: standing, bending, light lifting, and kneeling for up to the full work day. This is not necessarily a "sit down" job. Your signature on this form confirms that this is not a problem for you. I certify that the information on this application is accurate and complete. I hereby acknowledge notification that Steven DiFranco Inc. may request information regarding previous employment and personal history from the references listed, or from any other source. Date: ___________________ Signature: _____________________________________________________ Steven DiFranco Inc. is an equal opportunity employer
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