DCI/SHIRES, INC.
APPLICATION FOR EMPLOYMENT
TODAY'S DATE:
NAME:
SS#:
PRESENT ADDRESS:
PREVIOUS ADDRESS:
PHONE #:
REFERRED BY :
POSITION DESIRED :
DATE YOU CAN START :
NOTE: Every Field Must Be Completed For Acceptance Of Applications. You must CLICK SUBMIT at end to process.
SALARY DESIRED :
ARE YOU CURRENTLY EMPLOYED? :
MAY WE CONTACT YOUR EMPLOYER? :
HIGH SCHOOL:
GRADUATION DATE:
2 DIGIT MONTH & 4 DIGIT YEAR
COLLEGE:
GRADUATION DATE:
TRADE OR BUSINESS SCHOOL:
GRADUATION DATE:
SUBJECTS OF SPECIAL TRAINING, STUDY, RESEARCH WORK OR SPECIAL SKILLS:
US MILITARY SERVICE:
RANK:
EMPLOYER NAME:
EMPLOYER ADDRESS:
EMPLOYED FROM:
EMPLOYED TO:
EMPLOYER NAME:
EMPLOYER ADDRESS:
EMPLOYED FROM:
EMPLOYED TO:
EMPLOYER NAME:
EMPLOYER ADDRESS:
EMPLOYED FROM:
EMPLOYED TO:
NAME:
CITY:
YEARS KNOWN:
BUSINESS:
PHONE:
NAME:
CITY:
YEARS KNOWN:
BUSINESS:
PHONE:
NAME:
CITY:
YEARS KNOWN:
BUSINESS:
PHONE:
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on the application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability from any damage that may result from utilization of such information.
I also understand that online agencies may be used to investigate/verify social security numbers, driving records, criminal records, workers compensation history and hereby authorize their use.
I also understand that before any offer of employment is made, I will be required to submit a urine sample for drug screening.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time.
IMPORTANT: IF YOU WISH TO MAKE A COPY OF THIS APPLICATION PRINT NOW! BEFORE YOU SUBMIT.
EDUCATION
EMPLOYMENT DESIRED
PERSONAL INFORMATION
GENERAL
FORMER EMPLOYERS - LIST 4 (STARTING WITH LAST)
REFERENCES - LIST 3 YOU HAVE KNOWN AT LEAST ONE YEAR
AUTHORIZATION
STATE:
STATE:
STATE:
DATE:
SIGNATURE:
BY DATING AND TYPING YOUR NAME TO THIS DOCUMENT, YOU ARE AGREEING TO USE THIS DIGITAL MEANS AS AN "ELECTRONIC SIGNATURE" FOR THE PURPOSE OF SUBMITTING THIS EMPLOYMENT APPLICATION. IF YOU BECOME EMPLOYED BY OUR COMPANY, YOU WILL BE REQUIRED TO SIGN A HARD COPY OF AN APPLICATION ALONG WITH OTHER PERTINENT HIRING DOCUMENTS. BY CLICKING SUBMIT BELOW YOU AGREE TO ALL THE TERMS AND CONDITIONS SET FORTH HEREIN THIS APPLICATION.
EMPLOYER NAME:
EMPLOYER ADDRESS:
EMPLOYED FROM:
EMPLOYED TO:
