39 Union St., Berlin, NH 03570 * Phone: (603) 752-1500 * Fax: (603) 752-3155
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©2004 Caron Building Center

 
 
Employment Application

We are an Equal Opportunity Employer. It is our policy to abide by all Federal, State and local laws concerning discrimination in employment. No question in this application is intended to elicit information in violation of any such law nor will any information obtained in response to any question be used in violation of any such law.
 
Position Applied for:
First Name Last Name Middle
Address
Telephone
Email Address
Social Security #
If Employed and you are under 18,
can you furnish a work permit? Yes No
Have you filed and application here before? No Yes Date:
Have you ever been employed here before? No Yes Date:
Are you employed now? Yes No
Can we contact your employer? Yes
If hired, can you furnish proof that you are entitled
to work in the United States? Yes No
On what date would you be able to  work?
Are you available to work Full-time Part-time Temporary
Can you travel if a job requires it? Yes No
Have you been convicted of a felony within the last 7 years?
 No Yes Explain:
 

Personal References
Give name, address and telephone number of three references who are not related to you and are not previous employers.

Name and Occupation Address Phone Number

 
EDUCATION Elementary High College/University Graduate/Professional
School Name
Years Completed
Diploma / Degree
Course of Study

Describe Specialized Training, Apprenticeship, Skills, and Extra-curricular activities.
 
Summarize Special Skills and Qualifications acquired from employment or other experience such as specific office skills, machines used, etc.

 
Employment History
Employer
 Telephone
 Employed start date
 Employed end date
Address
 Job Title
 Starting Pay
 Final Pay
Supervisor
 Reason for Leaving
Work Performed
 
Employer
 Telephone
 Employed start date
 Employed end date
Address
 Job Title
 Starting Pay
 Final Pay
Supervisor
 Reason for Leaving
Work Performed
 
Employer
 Telephone
 Employed start date
 Employed end date
Address
 Job Title
 Starting Pay
 Final Pay
Supervisor
 Reason for Leaving
Work Performed

Applicant's Statement
By submitting this application form, I agree to the following statements:

I understand that this application is considered current for 90 days. If I want to be considered for employment after that time, I must renew my application in writing.

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment. I further understand said background check may also involve the Company's obtaining an investigative consumer report on me which may cover such areas as my character and general reputation.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.