Confidential Application for Employment

I understand and agree that any false information provided herein may be cause for denial of employment or dismissal in the event of employment. As an applicant for a position with Stenbeck & Taylor, Inc., I hereby authorize the release of information regarding my education and work history for use to determine my qualifications for employment.

Position Applied For:______________________________________Date: ___________________________

Signature:
______________________________________________________________________________
Name:
First:_________________________ MI: __________Last:________________________________________
Present Address:
Street: _________________________________________________________________________________
City: _________________________________________State: _______________ ZIP: _________________
Have you ever been convicted of a crime? _____Yes _____No
If Yes, describe in full:






Are you legally authorized to work in the United States? _____Yes _____No
Do you have a current Valid Driver's License? _____Yes _____No
Educational Background: (List most recent first)
School
Location
# of years
completed
Graduated
(Y / N)
Degree Received

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Skills And Qualifications:
List any Professional License or Certification that are currently valid:
Sate or other Licensing Authority
Year of Licensure
License No.
Expiration Date

 

 

       

 

 

       

 

 

       
Affiliations:
Name of Organization:
Type of Affiliation:
How Long?

 

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List special qualifications and/or skills with machines and equipment (office or survey equipment, public speaking, computer applications, computer hardware and software, etc...)
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Professional Experience: (You may attach a word document summarizing your experience)

Employer
Name / Address

Type of Business Dates of Employment Job Title Avg. Hrs per week

 

 

 

. . . .
Number of employees you supervised Starting Salary Ending Salary Describe your duties, responsibilities and accomplishments Why did you leave?

 

 

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May we contact this employer? _____Yes _____No

Professional Experience: (You may attach a word document summarizing your experience)

Employer
Name / Address

Type of Business Dates of Employment Job Title Avg. Hrs per week

 

 

 

. . . .
Number of employees you supervised Starting Salary Ending Salary Describe your duties, responsibilities and accomplishments Why did you leave?

 

 

. . . .
May we contact this employer? _____Yes _____No

Professional Experience: (You may attach a word document summarizing your experience)

Employer
Name / Address

Type of Business Dates of Employment Job Title Avg. Hrs per week

 

 

 

. . . .
Number of employees you supervised Starting Salary Ending Salary Describe your duties, responsibilities and accomplishments Why did you leave?

 

 

. . . .
May we contact this employer? _____Yes _____No
Upon request, candidate must provide documentation of any attainments claimed on this application form to include: certificates, visas, degrees, registrations, etc.
Your application will be held in confidence
Please mail to the attention of:
Laura Hahn, Office Manager
Stenbeck & Taylor, Inc.
844 Webster Street, Suite 3
Marshfield, MA 02050