Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
Position Applied For
*
Expected Salary
*
Date Available
*
MM
DD
YYYY
Will accept seasonal work?
Seeking summer work?
Do you have a driver's license?
Does your immigration status restrict or prohibit employment?
*
If you are applying for a sales position, list your top three geographic preferences
Are you willing to relocate?
Are you willing to travel?
Name of High School
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
I have a G. E. D.
Highest Grade Completed
Graduated
Grade 11
Grade 10
Grade 9
G.P.A.
List honors and awards
Name of Jr College
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Major area of study
Checkbox
Credits Completed
25 or less
45 or less
75 or less
80 or more
Degree Obtained
G. P. A.
List honors and awards
Name of University
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Major area of study
Did you Graduate?
Credits Completed
15 or less
45 or less
75 or less
80 or more
Degree Obtained
G. P. A.
List honors and awards
Name of Graduate School
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Major
Degree Obtained
G. P. A.
List honors and awards
Name and kind of other schools, seminar or training.
Name and kind of other schools, seminar or training.
Name and kind of other schools, seminar or training.
List any professional certifications or licenses.
List extra-curricular activities and hobbies.
Military Service
*
Yes
No
If yes
Date Entered
MM
DD
YYYY
Date Discharged
MM
DD
YYYY
Duties and Responsibilities
Service School or Special Trainings
Start date of service school or special trainings
MM
DD
YYYY
End Date
MM
DD
YYYY
Employer #1
*
Position/Title
*
Supervisor's Name
First Name
Last Name
Start Date
*
MM
DD
YYYY
End Date
MM
DD
YYYY
I currently work here
*
Yes
No
Employer's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Select One
Hourly
Weekly
Monthly
Yearly
Select One
*
Select One
*
May we contact this employer?
*
Yes
No
If no, why?
Describe your duties and responsibilities
Reason for leaving
Employer #2
Position/Title
Supervisor's Name
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer's Phone
(###)
###
####
Select One
Hourly
Weekly
Monthly
Yearly
Select One
Select One
May we contact this employer?
Yes
No
If no, why?
Describe your duties and responsibilities
Reason for leaving
Employer #3
Position/Title
Supervisor's Name
First Name
Last Name
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Employer Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer's Phone
(###)
###
####
Select One
Hourly
Weekly
Monthly
Yearly
Select One
Select One
May we contact this employer?
Yes
No
If no, why?
Describe your duties and responsibilities.
Employer #4
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Select One
Hourly
Weekly
Mothly
Yearly
Select One
Select One
May we contact this employer
Yes
No
If no, why?
Describe your duties and responsibilities.
How/why did you come to Brown & Haley?
Have you ever applied to work for us in the past?
If yes, what was the date of application?
MM
DD
YYYY
Position applied for
Previously employed by Brown & Haley
If yes, what position did you hold?
Start Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Reason for Leaving
Do you have any relatives who work for Brown & Haley?
*
If yes, what is their name and position held?
*
Have you ever been convicted of a felony within the last 7 years?
If yes, list offenses.
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date
MM
DD
YYYY
Write a short statement outlining your career objectives.
Personal Reference #1
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Occupation
*
Relationship
*
Personal Reference #2
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Occupation
Relationship
Personal Reference #3
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Occupation
Relationship
I herby certify that the information given in this application is correct and true to the best of my knowledge. I authorize Brown & Haley to contact any of my schools or former employers, except those indicated, and authorize these entities to furnish all information requested in connection with this employment application. I understand that if employed, any misrepresentation of the information furnished by me shall be sufficient case for dismissal. Additionally, I further understand that should I be employed by Brown & Haley, any and all claims I should have arising out of or relating to my employment, after all union preceedings (if applicable) have been exhausted, will be subjected to mandatory arbitration.
I understand that the employee or the employer can terminate employment at any time.
