Victor Packing

Applicant Information

Date

Last Name

First Name

Initial

Other Name(s) Used

Address

Phone

E-mail Address

Position Applied for

Referred By

Desired Salary

Are you eligible to work in the U.S.?

Y N

Are you at least 18 years or older?

Y N

If under 18, do you have a work permit?

Y N

Have you ever interviewed with this company before?

Y N

If yes, when?

Have you ever been employed by this company?

Y N

If yes, list date(s), job title(s):

Are you related to anyone who works for this company?

Y N

If yes, who?:

Have you ever been terminated from employment or asked to resign by an employer?

Y N

If yes, please provide company names and details

Can you work overtime, including weekends?

Y N

Are you currently employed?

Y N

If so may we inquire of your present employer?

Y N

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Y N

How did you hear about us?

CURRENT EMPLOYMENT Provide your most recent employment details.

Employer Name

Phone #

Supervisor Name/Title

From

Job Title

Employer Address

Reason for Leaving

Summarize the nature of work performed and job responsibilities

Disclaimer and Signature

Please read carefully before submitting.

I certify that the above information is true and correct. I understand that, in the event of my employment by Victor Packing, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.

I authorize Victor Packing to inquire into my educational, professional, and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to Victor Packing and will hold Victor Packing, and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made based on such information. I further authorize Victor Packing to obtain any credit and consumer check.

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with Victor Packing is intended to create an employment contract between myself and Victor Packing under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired; my employment will be terminable at will and may be terminated by me or Victor Packing at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.

I hereby acknowledge that I have read and agree to the above statements.

Application

Staff Accountant

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Applicant Information