Stenbeck & Taylor - Application for Employment

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?
		.		.
		.		.
		.		.
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?
	.	.	.	.
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