MaGerks Employment Application Desired work location  Bel Air Federal Hill

Personal Information

First Name	Social Security No.
Last Name
Present Address  Apt.No.
City  State  Zip
Permanent Address  Apt.No.
City  State  Zip
Are you 18 years or older?  Yes No
Phone

Desired Employment

Position Date you can start Salary desired
Are you employed now?  Yes No If so, may we inquire of your present employer?  Yes No
Ever applied to this company before?  Yes No Where?       When?
Ever worked to this company before?  Yes No Where?       When?
Reason for leaving
Name of last supervisor at this company
Who referred you to this company?	Employment Agency Newspaper Advertising Friend State Employment Office College Placement Service Walk In Other

Education

School Level	Name and Location of School	No. Of Years Attended	Did you Graduate?	Subjects Studied
Grammar School
High School
College
Trade, Business or Correcspondence School

General

Subjects of special study or research work
Special Training
Special Skills

Former Employers
List below last three employers, starting with the most recent

Name of present or last employer
Address  City  State  Zip
Starting Date  Leaving Date  Job Title
Weekly Starting Salary  Weekly Final Salary  May we contact your supervisor  Yes No
Name of Supervisor  Title  Phone
Description of Work
Reason for Leaving

Name of previous employer
Address  City  State  Zip
Starting Date  Leaving Date  Job Title
Weekly Starting Salary  Weekly Final Salary  May we contact your supervisor?  Yes No
Name of Supervisor  Title  Phone
Description of Work
Reason for Leaving

Name of previous employer
Address  City  State   Zip
Starting Date   Leaving Date   Job Title
Weekly Starting Salary   Weekly Final Salary   May we contact your supervisor  Yes No
Name of Supervisor   Title   Phone
Description of Work
Reason for Leaving

References
Below give the names of three persons you are not related to, whom you have known at least one year.

	Name	Address	Business	Years Acquainted
1		Address  City   State   Zip
2		Address  City   State   Zip
3		Address  City   State   Zip

Service Record

Branch of Service
Discharge Date
Rank

Have you been convicted of a felony within the last 5 years?  Yes No

If yes, explain. (Will not necessarily exclude you from consideration)

Authorization

"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 this 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 for any damage that may result from utilization of such information.

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, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

Submission of this application is not guaranteed to be secure. MaGerks is not responsible for any interception or loss of data during the transmission of this form."