Personal Information

Candidate's Name:
Name is required.
Address: Address is required.
City:
City is required.
State:
State is required.
Zip:
Zip is required.
Phone Number:
Phone is required.
Email Address: Email is required.Invalid format.
Are you 18 years of
age or older?
Yes No
Are you either a U.S. citizen or an alien authorized to work in the U.S.? Yes No
Have you ever worked or attended school under another name? If so, under what name?
Yes No
If so, under what name?

 

Position Desired

Position: A value is required.
Start date available: A start date is required.
Wage rate desired: $
Do you prefer:
If part-time, hours per
week desired:
Hours you are available
to work:
A value is required.
Days of week you are
available to work:
A value is required.
Are you able to work: Weekends   Holidays   Nights Overtime None Minimum number of selections not met.

Have you worked for
K.E. Greene before?

Yes No
 

If so, dates of employment?

Reason for leaving?

How did you learn about
this opening?
A value is required.

 

Education

Type of School Graduated? Course of Study
High School: Yes No
Technical School: Yes No
College/University: Yes No
Post-Graduate Ed:
Additional Schools: Yes No

 

Skills

Typing speed (WPM):
Are you experienced in using personal computers?
Please make a selection.
What software experience do you have that would typically be used in the workplace? (e.g. Microsoft Word, Excel, Quickbooks, etc.)?


Work Experience
(List all previous employment, most recent first.):

Employer: Required.  Phone: Required.
Address: A value is required.
Start date: Required. End date: Required.
Position Held: Required. Salary: Required.
Description of Duties:
Required.

Employer:   Phone:
Address:
Start date: End date:
Position Held: Salary:
Description of Duties:

 

References
(Identify three persons who know your work, most recent first.):

Name:
Required.
Address:
Phone:
Required.
Business:
Years Known:
Required.
Invalid format.

Name:
Required.
Address:
Phone:
Required.
Business:
Years Known:
Required.
Invalid format.

Name:
Required.
Address:
Phone:
Required.
Business:
Years Known:
Required.
Invalid format.

 

Authorization and Acknowledgements
I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge.

I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.

Signature: Required.    Date: Required.

Anti-spam: What is 8 plus 4? Wrong.Wrong.Wrong.Wrong.

I have read and agree to these Authorization and Acknowledgements.