Application For Employment PERSONAL INFORMATIONYou can also print this application HERE and send by fax, based on location, to the following: Safford 928-348-2367 Full Name* Date* Date Format: MM slash DD slash YYYY Present Address* Street Address City State / Province / Region ZIP / Postal Code Permanent Address* Street Address City State / Province / Region ZIP / Postal Code Phone Number*Email* Are you 18 years older?*yesNoAre you prevented from lawfully becoming employed in this country because of VISA and IMMIGRATION status?*YesNoWhich location are you applying for employment?*Winnemucca, NVSafford, AZFarmington, NMEMPLOYMENT DESIREDPosition Desired:*Date You Can Start:*Salary Desired:*Are you Employed Now?*YesNoIf so, may we contact your present employer?*YesNoEver Applied to this Company Before?*YesNoWhen?Where?Referred By:EDUCATIONHigh SchoolName and Location of SchoolNumber of years attendedDid you graduate?Subjects studied CollegeName and Location of SchoolNumber of years attendedDid you graduate?Subjects studiedList any other schools, degrees or information Trade, Business or correspondence schoolName and Location of SchoolNumber of years attendedDid you graduate?Subjects studiedGENERALSubjects of special study or research work:Special Skills:Activities:U.S. Military or Naval Service:Rank:Present Membership In National Guard or reserves:Former Employers (List below last three employers, starting with the last one first)Name and address of Employer :Salary :From : Date Format: MM slash DD slash YYYY To : Date Format: MM slash DD slash YYYY Position :Reason for leaving :What did you like most about this job? 2nd Employer Name and address of 2nd Employer :Salary :From : Date Format: MM slash DD slash YYYY To : Date Format: MM slash DD slash YYYY Position :Reason for leaving :What did you like most about this job? 3rd Employer Name and address of 3rd Employer :Salary :From : Date Format: MM slash DD slash YYYY To : Date Format: MM slash DD slash YYYY Position :Reason for leaving :What did you like most about this job?Which of these jobs did you like best?References (Give the name of three persons not related to you, whom you have known for at least one year) Name :Address :Business :Years Acquainted 2nd Reference Name :Address :Business :Years Acquainted 3rd Reference Name :Address :Business :Years Acquainted In case of an emergency notify Name :AddressPhone No.“I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated , with or without cause, and with or without notice, at any time, at either my or the company’s opinion. I also understand and agree that the terms and conditions or my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.”
