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Employment >> Employment Application

Personal Information

Name (Last, first):	Social Security Number	Date of Birth
Present Address	City	State	Zip
Permanent Address(if different from above):	City	State	Zip
Phone Number	Referred By

Employment Desired

Position	Date You Can Start	Rate/Salary Desired
Are You Employed?	If So, May We Contact Your Present Employer?
Have you applied at Allfirst before?	Where?	When?

Education History

Name of School	Location	Years Attended	Did you graduate?	Subject Studied
Grammar School
High School
College
Trade, Business, or Correspondence School

General Information

Subjects of Special Study/Research Work or Special Training/Skills
US Military or Naval Service	Rank

Former Employers (Last four employers, starting with the last one first)

Date, Month, Year	Employer Info (Company, Supervisor, Phone)	Salary	Position	Reason for Leaving
From To
From To
From To
From To

References (Three persons not related to you, whom have known you at least one year)

Name	Phone Number	Address	Business	Years Known

Emergency Contacts

Name	Relationship	Address	Phone(Home)	Phone(Work)

Are you allergic to any medications?

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 authorized 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."

Signature:
(Your Initials Here)