Employment Application
DeGeorge Management
Full Name
*
First, Middle, Last
Address
*
Full Physical Home Address
Phone:
*
Primary Phone Number
Email
*
Position Applied For:
*
Type of Employment:
*
A
Full-Time
B
Part-Time
C
Contractor
Have you worked for us before?
*
A
Yes, and I gave proper notice
B
Yes, and I left without notice
C
Yes, and I was let go
D
No, I have never worked here
Are you at least 18 years old?
*
A
Yes
B
No
Date of Birth
*
MM/DD/YYYY
Social Security Number
SSN or TIN - Enter Now or you may provide after interview.
Are you legally authorized to work in the US?
*
A
Yes
B
No
Do you have reliable transportation to work?
*
A
Yes
B
No
Education, Experience, and References
For the next section please fill out all relevant information. You may also upload a full resume and cover letter if desired.
Education
High School
Name and location of School(s). # of Years Attended. Degree Received.
College or University
Name and location of School(s). # of Years Attended. Degree Received.
Trade, Business, or Correspondence School
Name and location of School(s). # of Years Attended. Degree Received.
Additional Education
Name and location of School(s). # of Years Attended. Degree Received. Please list any additional professional certifications, memberships to professional associations and/or other skills you believe are worthwhile to this position.
Work History
Job 1
Employer Name
Name of Most Recent Employer
Employer Location
Location of Most Recent Employer
Employer Phone
Phone Number of Most Recent Employer
Job Title
Position Held
Length of Employment
From "When " To "When "
Name of Supervisor
Reason for Leaving
Job 2
Employer Name
Name of Most Recent Employer
Employer Location
Location of Most Recent Employer
Employer Phone
Phone Number of Most Recent Employer
Job Title
Position Held
Length of Employment
From "When " To "When "
Name of Supervisor
Reason for Leaving
Job 3
Employer Name
Name of Most Recent Employer
Employer Location
Location of Most Recent Employer
Employer Phone
Phone Number of Most Recent Employer
Job Title
Position Held
Length of Employment
From "When " To "When "
Name of Supervisor
Reason for Leaving
Professional References
*
Please provide the name and phone number of three professional references. A professional reference is a person that can attest to your professional development, qualifications, successes, and speak to your ability to perform the duties of this position satisfactorily. They may be a previous employer, supervisor, co-worker, teacher, professor, affiliate of a professional association, or other. Please do not list personal family members, friends or acquaintances.
Upload Attachments
Choose a file or drag it here.
Uploading...
You can upload one or more files. Such as, Resume, Cover Letter, References, Photo ID, etc.
APPLICATION DISCLAIMER AND ACKNOWLEDGMENT
By Signing you hereby certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I hereby authorize any of the persons or organizations listed in my application to give all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and release all such parties from all liability that may result from furnishing such information to you. I understand that if I am selected to continue in the hiring process I will be asked to participate in a formal background check including review of driver’s abstract during a later part of the interview process. I understand that the driver’s abstract will be supplied at my expense, of which will be reimbursed if I am hired. I authorize DeGeorge Management, LLC. and/or. (“Company”) to request and receive such information. In consideration for my employment and my being considered for employment by your company, I agree to adhere to the rules and regulations of the company and hereby acknowledge that these rules and regulations may be changed by your company at any time, at the company’s sole option and without any prior notice. In addition, I acknowledge that my employment may be terminated, and any offer of employment, if such is made, may be withdrawn, with or without prior notice, at any time, at the option of either the company or me. I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to assure or make some other personnel move, either prior to commencement of employment or after I have become employed, or to assure any benefits or terms and conditions of employment, or to make any agreement, that is contrary to the foregoing. I hereby acknowledge that that this application will remain active for no more than 90 days and retained for no longer than one year from the date it was signed.
Signature
*
Draw
Type
Upload
Choose your signature image
Your form has been saved. You can complete it using this link within %(day)s days.
Copy
Submit