MaGerks Employment Application

Desired work location    * mandatory

Personal Information

First Name   
Last Name 

Present Address  Apt.No. 
City  State  Zip  

Permanent Address  Apt.No. 
City  State  Zip  

Are you 18 years or older? 

Phone  * mandatory
Email  

Desired Employment

Position
Date you can start
Salary desired

Are you employed now? 
If so, may we inquire of your present employer? 

Ever applied to this company before? 
Where?       When? 
Ever worked to this company before? 
Where?       When? 

Reason for leaving
Name of last supervisor at this company
Who referred you to this company?





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 
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? 
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 
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? 
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."