Application for FREED Employment – Page 2
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OTHER
INFORMATION: |
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Subjects of special study
or research work: |
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Special training: |
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Activities: (Civic,
Athletic, etc.) |
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Exclude organizations, the name or character of which
indicates the race, creed, sex, marital status, age, color or national origin
of its members. |
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FORMER
EMPLOYERS: List the last four employers, starting with present
or most recent. |
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Date: (Month & Year) |
Name & Address of Employer |
Salary |
Position |
Reason for Leaving |
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To: |
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$ |
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From: |
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Per: |
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To: |
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$ |
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From: |
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Per: |
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To: |
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$ |
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From: |
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Per: |
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To: |
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$ |
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From: |
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Per: |
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REFERENCES: Give the names of three persons not related to you, whom you have known at least one year. |
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Name |
Address |
Phone |
Business |
Yrs. Known |
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1. |
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2. |
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3. |
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IN CASE OF EMERGENCY, NOTIFY:__________________________________________
ADDRESS: _________________________________________
PHONE: ________________
I authorize investigation of
all statements contained in this application. I understand that misrepresentation or omission of facts
called for is cause for dismissal.
Further, I understand and agree that my employment is for no definite
period and may, at the discretion of the employer, be terminated at any time,
without any previous notice.
SIGNED: _____________________________________________
DATE: ________________
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